Provider Demographics
NPI:1124712807
Name:BENNAMON, EUNICE DENISE
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:DENISE
Last Name:BENNAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-3341
Mailing Address - Country:US
Mailing Address - Phone:662-516-8668
Mailing Address - Fax:
Practice Address - Street 1:315 N MADISON ST
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3341
Practice Address - Country:US
Practice Address - Phone:662-516-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor