Healthcare Provider Details

I. General information

NPI: 1760157259
Provider Name (Legal Business Name): SHIE BENISTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5329 OLEANDER DR STE 206
WILMINGTON NC
28403-5841
US

IV. Provider business mailing address

201 N FRONT ST STE 512
WILMINGTON NC
28401-5092
US

V. Phone/Fax

Practice location:
  • Phone: 828-557-4380
  • Fax:
Mailing address:
  • Phone: 910-202-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC014378
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC014378
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: