Doctor Name: | BENJAMEN DAVID POITRA |
NPI Number: | 1841632528 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 684-5-1-11 |
Business Practice Address: | 1058 College Dr New Town, ND - 587639112 |
Business Phone Number: | 7016274750 |
Business Fax Number: | 7016272810 |
Mailing Address: | 1058 College Dr, NEW TOWN |
State: | ND |
Postal Code: | 587639112 |
Phone Number: | 7016274750 |
Fax Number: | 7016272810 |
NPI Enumeration Date: | 07/23/2013 |
NPI Last Update Date: | 07/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 684-5-1-11 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |