Healthcare Provider Details

I. General information

NPI: 1760279228
Provider Name (Legal Business Name): MAEB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 HUFFMAN MILL RD STE 203
BURLINGTON NC
27215-5113
US

IV. Provider business mailing address

PO BOX 3
MC LEANSVILLE NC
27301-0003
US

V. Phone/Fax

Practice location:
  • Phone: 336-298-8088
  • Fax: 464-777-8135
Mailing address:
  • Phone: 336-298-8088
  • Fax: 464-777-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAEDORA MARYLOUISE BENTON
Title or Position: OWNER/CEO
Credential: NP
Phone: 678-499-7794