Nicole N Benton, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

008941 Issued in GA

Practice address

1194 147TH St Ste 5
Monticello, GA 31064-8068

Phone

(678) 561-3091

Fax

(404) 795-8974

NPI assigned

Apr 20, 2016

Last updated

Jan 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• NNK Behavioral Health Group LLC

  dba NNK 4 L.I.F.E.

  • Mental Health Counselor
  • Monticello, GA
  • NPI 1588178487

  Addiction (Substance Use Disorder)

  NPD Authorized official
• Reconciliation Movement, Inc

  • Voluntary or Charitable Agency
  • Riverdale, GA
  • NPI 1598279432
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1083068647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3826 SALEM RD # 136",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164528",
            "telephone_number": "678-561-3091",
            "fax_number": "404-795-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1194 147TH ST STE 5",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310648068",
            "telephone_number": "678-561-3091",
            "fax_number": "404-795-8974"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Highway 138 SW",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "GA",
            "postal_code": "302743908",
            "country_code": "US",
            "telephone_number": "678-561-3091",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16 W Peachtree St",
            "address_purpose": "LOCATION",
            "city": "Norcross",
            "state": "GA",
            "postal_code": "300712046",
            "country_code": "US",
            "telephone_number": "678-561-3091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENTON",
        "first_name": "NICOLE",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-20",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "008941",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "007682",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003181947J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amyhersch Home Care
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• Oliver J Barron, DDS
• Shannon T Barton
• Rachael Beverage, DC
• Kirk Tahama Brown, M.D.
• Skye D Camp, PT
• Cardiac Disease Specialists, PC
• Drew Carroll, APC

• Mental Health Counselor in Monticello, GA
• Providers in Monticello, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.