Healthcare Provider Details

I. General information

NPI: 1477460046
Provider Name (Legal Business Name): BENJAMIN HOUSTON CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

86 JONATHAN LUCAS ST
CHARLESTON SC
29425-2300
US

IV. Provider business mailing address

99 WESTEDGE ST APT 218
CHARLESTON SC
29403-4980
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-5050
  • Fax: 843-876-8085
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number343
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: