Healthcare Provider Details

I. General information

NPI: 1083544902
Provider Name (Legal Business Name): RONILYN BENTLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E FRONT ST UNIT 843
CLAYTON NC
27528-0237
US

IV. Provider business mailing address

604 E FRONT ST UNIT 843
CLAYTON NC
27528-0237
US

V. Phone/Fax

Practice location:
  • Phone: 480-205-7304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22903
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: