Healthcare Provider Details

I. General information

NPI: 1386047462
Provider Name (Legal Business Name): SHAWANDA BENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6554 FLORIDA BLVD STE 1102523
BATON ROUGE LA
70806-4474
US

IV. Provider business mailing address

6554 FLORIDA BLVD STE 1102523
BATON ROUGE LA
70806-4474
US

V. Phone/Fax

Practice location:
  • Phone: 225-350-4096
  • Fax:
Mailing address:
  • Phone: 225-350-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5070
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: