Organization Name: | BENJAMIN COUNSELING CENTER |
NPI Number: | 1205134962 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANNETTA SERENA BENJAMIN (LICENSED PROFESSIONAL COUNSELOR) |
Mailing Address: | 7614 Sheffield Green Way Lorton |
State: | VA US |
Postal Code: | 220791710 |
Phone Number: | 7035991852 |
Fax Number: | 1866668453 |
NPI Enumeration Date: | 03/04/2011 |
NPI Last Update Date: | 03/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701004674 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |