Individual
MS. KERYN JOHNSON BENASULY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2000 RIVERSIDE PKWY STE 107, LAWRENCEVILLE, GA 30043-5926
(678) 878-3215
(678) 878-3341
Mailing address
BRIDGEWAY HOSPICE, 2000 RIVERSIDE PKWY SUITE 107, LAWRENCEVILLE, GA 30043
(678) 878-3215
(678) 878-3341
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006320
GA
Other
Enumeration date
03/04/2018
Last updated
03/04/2018
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