Individual
GLEN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
304 PIERCE AVE, MACON, GA 31204-2422
(404) 314-9752
Mailing address
304 PIERCE AVE, MACON, GA 31204-2422
(404) 314-9752
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
GA
Other
Enumeration date
03/01/2016
Last updated
07/29/2024
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