Healthcare Provider Details

I. General information

NPI: 1205134962
Provider Name (Legal Business Name): BENJAMIN COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7614 SHEFFIELD GREEN WAY
LORTON VA
22079-1710
US

IV. Provider business mailing address

12504 LAKE RIDGE DR SUITE C
WOODBRIDGE VA
22192-2390
US

V. Phone/Fax

Practice location:
  • Phone: 703-599-1852
  • Fax: 186-666-8453
Mailing address:
  • Phone: 703-599-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004674
License Number StateVA

VIII. Authorized Official

Name: MS. ANNETTA SERENA BENJAMIN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC, NCC
Phone: 703-599-1852