1396136925 NPI number — SHONA M JONES BENNETT LPC, NCC, MED, MS

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396136925 NPI number — SHONA M JONES BENNETT LPC, NCC, MED, MS

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JONES BENNETT

Provider First Name:

SHONA

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

LPC, NCC, MED, MS

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

JONES BENNETT

Provider Other First Name:

SHONA

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

CPCS, CAMSII, GCSC

Provider Other Last Name Type Code:

5

NPI Number:

1396136925

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/12/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 2036

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

TIFTON

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

31793-2036

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

229-392-4457

Provider Business Mailing Address Fax Number:

229-382-8353

Provider First Line Business Practice Location Address:

1216 DAWSON RD STE 110

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ALBANY

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

31707-3800

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

229-392-4457

Provider Business Practice Location Address Fax Number:

229-382-8353

Provider Enumeration Date:

02/18/2015

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 101Y00000X , with the licence number:  LPC008251 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YM0800X , with the licence number: LPC008251 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YS0200X , with the licence number: 641060 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YP2500X , with the licence number: 008251 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 79770372 . This is a "DUN & BRADSTREET (DUNS ID#)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: A922342 . This is a "AMERICAN HEALTHCARE ACADEMY (CPR AND AED CERTIFICATION)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 003157272A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 13509476 . This is a "CAQH PROVIEW PROVIDER REGISTRY (CAQH PROVIDER #)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: NCC668043 . This is a "NATIONAL BOARD OF CERTIFIED COUNSELORS (NCC CERTIFICATION)" identifier . This identifiers is of the category "OTHER".
• Identifier: 1835 . This is a "HIGH IMPACT TRAINING AND COUNSELING, INC. (CAMS-II CERTIFICATION)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 6426956 . This is a "AMERICAN COUNSELING ASSOCIATION (ACA)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 2079 . This is a "LPCAGA (CERTIFIED PROFESSIONAL COUNSELOR SUPERVISOR - CPCS)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 30967662 . This is a "THE LICENSED PROFESSIONAL COUNSELORS ASSOCIATION OF GEORGIA (LPCAGA)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 641060 . This is a "GEORGIA PROFESSIONAL STANDARDS COMMISSION (CERT. EDUCATOR IN SCHOOL COUNSELING)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: LPC008251 . This is a "GEORGIA COMPOSITE BOARD OF PROFESSIONAL COUNSELORS, SWS, MFTS (LPC LICENSE)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 020720170 . This is a "THE JOHN PRAED FOUNDATION (ANSA CERTIFICATION)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".