Provider Demographics
NPI:1962408294
Name:BENDER, MARNETTE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARNETTE
Middle Name:ANN
Last Name:BENDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARNETTE
Other - Middle Name:BENDER
Other - Last Name:GRALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 E TRINITY PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3302
Mailing Address - Country:US
Mailing Address - Phone:404-518-1018
Mailing Address - Fax:770-962-1886
Practice Address - Street 1:118 E TRINITY PL
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3302
Practice Address - Country:US
Practice Address - Phone:404-518-1018
Practice Address - Fax:770-962-1886
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical