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Individual

BENAJAH MARION

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW, LMFT

Contact information

Practice address
16 TALLOKAS RD, MOULTRIE, GA 31768-5961
(229) 891-2819
Mailing address
16 TALLOKAS RD, MOULTRIE, GA 31768-5961
(229) 891-2819

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW000901
GA
106H00000X
Marriage & Family Therapist
MFT 000497
GA

Other

Enumeration date
07/11/2016
Last updated
07/11/2016
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