Provider Demographics
NPI:1528337854
Name:DEANNA BENNER COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:DEANNA BENNER COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:609-784-8217
Mailing Address - Street 1:774 EAYRESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-3100
Mailing Address - Country:US
Mailing Address - Phone:609-784-8217
Mailing Address - Fax:
Practice Address - Street 1:774 EAYRESTOWN RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-3100
Practice Address - Country:US
Practice Address - Phone:609-784-8217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053040001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty