Individual
MS. SHADONA RENE' BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAFP
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(770) 339-2345
Mailing address
1241 FLAT ROCK RD, MADISON, GA 30650-3140
(706) 343-0006
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/10/2012
Last updated
05/10/2012
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