Provider Demographics
NPI:1487498119
Name:DEIGNAN, BENJAMIN (MSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:DEIGNAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 DEKALB AVE NE APT 114
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-5607
Mailing Address - Country:US
Mailing Address - Phone:404-514-8380
Mailing Address - Fax:
Practice Address - Street 1:555 COLONIAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3766
Practice Address - Country:US
Practice Address - Phone:678-856-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health