Healthcare Provider Details

I. General information

NPI: 1225375413
Provider Name (Legal Business Name): CHARNELL BENJAMIN-CARTER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10305 BOGGY MOSS DR
RIVERVIEW FL
33578-9503
US

IV. Provider business mailing address

10305 BOGGY MOSS DR
RIVERVIEW FL
33578-9503
US

V. Phone/Fax

Practice location:
  • Phone: 813-205-0079
  • Fax:
Mailing address:
  • Phone: 813-205-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH-17419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: