Healthcare Provider Details

I. General information

NPI: 1639767999
Provider Name (Legal Business Name): BERNICE BENSON-SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 WOODBURY HWY
GREENVILLE GA
30222-1514
US

IV. Provider business mailing address

756 WOODBURY HWY
GREENVILLE GA
30222-1514
US

V. Phone/Fax

Practice location:
  • Phone: 706-672-1118
  • Fax: 706-672-1918
Mailing address:
  • Phone: 706-672-1118
  • Fax: 706-672-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: