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General NPI Number Information
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NPI Number | 1588178487
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Entity Type | Organization
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Legal Business Name | NNK BEHAVIORAL HEALTH GROUP LLC
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 1194 147TH ST STE 5
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City | MONTICELLO
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State | GA
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Zip | 31064-8068
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Country | US
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Telephone | 678-561-3091
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Fax | 404-795-8974
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Provider Business Mailing Address
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Address Line | 3826 SALEM RD # 136
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City | COVINGTON
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State | GA
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Zip | 30016-4528
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Country | US
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Telephone | 678-561-3091
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Fax | 404-795-8974
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Authorized Official
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Title or Position | CEO
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Name | DR. NICOLE N BENTON
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Credential | LPC
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Telephone | 404-438-3677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8941
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8941
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License Number State | GA
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