Healthcare Provider Details

I. General information

NPI: 1114840964
Provider Name (Legal Business Name): BENJAMIN ROBERT DAVIS CADC, CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 MORNINGSIDE DR
WILMINGTON NC
28401-7241
US

IV. Provider business mailing address

522 MORNINGSIDE DR
WILMINGTON NC
28401-7241
US

V. Phone/Fax

Practice location:
  • Phone: 252-813-0872
  • Fax:
Mailing address:
  • Phone: 252-813-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-28194
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2023-10849-01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: