| Doctor Name: | MARY BENTON |
| NPI Number: | 1548426240 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | APC001278 |
| Business Practice Address: | 250 W Pine St Colquitt, GA - 398373532 |
| Business Phone Number: | 2297585090 |
| Business Fax Number: | |
| Mailing Address: | 1120 W Broad Ave, ALBANY |
| State: | GA |
| Postal Code: | 317074397 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/01/2008 |
| NPI Last Update Date: | 08/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | APC001278 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |