Healthcare Provider Details

I. General information

NPI: 1659204154
Provider Name (Legal Business Name): SCARLETT NICOLE BENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BRANCHWOOD DR STE C
JACKSONVILLE NC
28546-5919
US

IV. Provider business mailing address

302 OLD POND CT
JACKSONVILLE NC
28540-8063
US

V. Phone/Fax

Practice location:
  • Phone: 843-592-8582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: