Healthcare Provider Details

I. General information

NPI: 1750193009
Provider Name (Legal Business Name): BENJAMIN PHAM LCMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 ASHVILLE AVE
CARY NC
27518-6660
US

IV. Provider business mailing address

226 ASHVILLE AVE
CARY NC
27518-6660
US

V. Phone/Fax

Practice location:
  • Phone: 984-263-9990
  • Fax:
Mailing address:
  • Phone: 984-263-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22665
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: