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General NPI Number Information
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NPI Number | 1831485523
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Entity Type | Individual
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Provider Name | ANNETTE JACKSON BENNECHE LPC, M.S., M.ED.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 110 N MAIN ST
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City | GREENSBORO
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State | GA
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Zip | 30642-1108
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Country | US
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Telephone | 706-453-7400
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Fax | 855-898-5414
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Provider Business Mailing Address
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Address Line | 110 NORTH MAIN STREET DBA: SERVE, LLC
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City | GREENSBORO
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State | GA
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Zip | 30642-3203
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Country | US
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Telephone | 706-453-7400
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Fax | 855-898-5414
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 006255
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 006255
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License Number State | GA
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