Provider Demographics
NPI:1437743481
Name:HEATH, BENJAMIN HANCOCK (LPC, MA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HANCOCK
Last Name:HEATH
Suffix:
Gender:M
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 MOUNTAIN PARK WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-3427
Mailing Address - Country:US
Mailing Address - Phone:770-616-6673
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE STE 110
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:888-551-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional