MEDICARE: SHANAE NICOLE BENITO 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	101YP2500X	Professional Counselor	LPC016440	GA

General Provider Information

NPI Number	:	1427825587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANAE NICOLE BENITO LPC

Provider Business Mailing Address
First Line	:	1401 PEACHTREE ST NE STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3005
Country	:	US
Telephone Number	:	470-749-3520
Fax Number	:	470-378-1997

Provider Business Practice Location Address
First Line	:	1401 PEACHTREE ST NE STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3005
Country	:	US
Telephone Number	:	470-749-3520
Fax Number	:	470-378-1997

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

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	03/24/2026

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