NNK Behavioral Health Group LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8941 Issued in GA

Legal business name

NNK BEHAVIORAL HEALTH GROUP LLC

Doing business as

NNK 4 L.I.F.E.

Practice address

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

Phone

(678) 561-3091

Fax

(404) 795-8974

NPI assigned

Nov 30, 2017

Last updated

Dec 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nicole N Benton, LPCNPI 1083068647

Title

Ceo

Phone

(404) 438-3677

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• NNK 4 L.I.F.E. Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole N Benton, LPC

  • Mental Health Counselor
  • Monticello, GA
  • NPI 1083068647

  Addiction (Substance Use Disorder)

  NPD Authorized official

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

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1588178487",
    "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": "3885 Crestwood Pkwy NW Ste 200",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "GA",
            "postal_code": "300965004",
            "country_code": "US",
            "telephone_number": "678-561-3091",
            "fax_number": "404-795-8974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Georgia 138",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "GA",
            "postal_code": "302743027",
            "country_code": "US",
            "telephone_number": "678-561-3091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NNK BEHAVIORAL HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-30",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "BENTON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-438-3677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "8941",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "8941",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003181947A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003181947J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NNK 4 L.I.F.E.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NNK 4 L.I.F.E.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Dec 31, 2024; 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.