Provider Demographics
NPI:1174980890
Name:BENFIELD, DIANE P (LCSW, CST)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:BENFIELD
Suffix:
Gender:F
Credentials:LCSW, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:3402 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6214
Practice Address - Country:US
Practice Address - Phone:138-753-9508
Practice Address - Fax:813-872-2741
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW118991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical