Individual
MRS. KIMBERLY BROOKE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1005 SHIRLEY AVE, DOUGLAS, GA 31533
(912) 389-4188
Mailing address
1005 SHIRLEY AVE, DOUGLAS, GA 31533-2123
(912) 389-4188
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
865
GA
104100000X
Social Worker
MSW005671
GA
1041C0700X
Clinical Social Worker
Primary
CSW005427
GA
Other
Enumeration date
11/09/2012
Last updated
06/03/2015
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