Healthcare Provider Details

I. General information

NPI: 1659282317
Provider Name (Legal Business Name): MEREDITH SUSANNE BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 ROSWELL RD UNIT 10F
SANDY SPRINGS GA
30328-2229
US

IV. Provider business mailing address

123 CLARENDON RD
COCHRAN GA
31014-7926
US

V. Phone/Fax

Practice location:
  • Phone: 478-230-2601
  • Fax:
Mailing address:
  • Phone: 478-230-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017239
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: