Healthcare Provider Details

I. General information

NPI: 1013496041
Provider Name (Legal Business Name): WILLIAM LAWRENCE BENTON LCMHC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 STIRRUP CREEK DR
DURHAM NC
27703-9464
US

IV. Provider business mailing address

4024 STIRRUP CREEK DR
DURHAM NC
27703-9464
US

V. Phone/Fax

Practice location:
  • Phone: 919-908-9730
  • Fax:
Mailing address:
  • Phone: 919-908-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009087
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: