Provider Demographics
NPI:1285060202
Name:BENNEFIELD, MICHELE BLACKWELL (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:BLACKWELL
Last Name:BENNEFIELD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2251
Mailing Address - Country:US
Mailing Address - Phone:864-313-9032
Mailing Address - Fax:866-808-0926
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2251
Practice Address - Country:US
Practice Address - Phone:864-313-9032
Practice Address - Fax:866-808-0926
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5669101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional