Healthcare Provider Details

I. General information

NPI: 1902760648
Provider Name (Legal Business Name): BEN BENTLEY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 HENNING DR STE 4
WINSTON SALEM NC
27106-4502
US

IV. Provider business mailing address

5335 ROBINHOOD VILLAGE DR STE 131
WINSTON SALEM NC
27106-9820
US

V. Phone/Fax

Practice location:
  • Phone: 336-905-9532
  • Fax:
Mailing address:
  • Phone: 336-905-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN KERMIT BENTLEY
Title or Position: OWNER
Credential: LCMHCS,LCAS,CCS
Phone: 336-905-9532