Healthcare Provider Details

I. General information

NPI: 1336070333
Provider Name (Legal Business Name): LILIANA BENAVIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 RAEFORD RD STE 2
FAYETTEVILLE NC
28305-5086
US

IV. Provider business mailing address

PO BOX 9909
FAYETTEVILLE NC
28311-9094
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-6336
  • Fax: 188-897-2839
Mailing address:
  • Phone: 910-485-6336
  • Fax: 188-897-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22133
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: