Organization
NNK BEHAVIORAL HEALTH GROUP LLC
Active
Other names
NNK 4 L.I.F.E.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE N BENTON LPC (CEO)
(404) 438-3677
Entity
Organization
Contact information
Practice address
1194 147TH ST STE 5, MONTICELLO, GA 31064-8068
(678) 561-3091
(404) 795-8974
Mailing address
3826 SALEM RD # 136, COVINGTON, GA 30016-4528
(678) 561-3091
(404) 795-8974
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
8941
GA
101YM0800X
Mental Health Counselor
Primary
8941
GA
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003181947A
—
GA
05
—
003181947J
—
GA
Enumeration date
11/30/2017
Last updated
12/31/2024
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