Healthcare Provider Details

I. General information

NPI: 1649186487
Provider Name (Legal Business Name): BENITA R CLOWARD M.S. CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SHILOH RD NW STE 710
KENNESAW GA
30144-7157
US

IV. Provider business mailing address

1301 SHILOH RD NW STE 710
KENNESAW GA
30144-7157
US

V. Phone/Fax

Practice location:
  • Phone: 404-706-6931
  • Fax:
Mailing address:
  • Phone: 404-706-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC011459
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: