MEDICARE: MRS. BENITA CAMPBELL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	006701	GA

General Provider Information

NPI Number	:	1033680087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BENITA CAMPBELL LPC

Provider Business Mailing Address
First Line	:	1404 LANDON DR
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-2462
Country	:	US
Telephone Number	:	770-315-3177
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 W PEACHTREE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-1118
Country	:	US
Telephone Number	:	770-315-3177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	01/23/2025

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