Healthcare Provider Details

I. General information

NPI: 1891489985
Provider Name (Legal Business Name): SYDNEY MARIE BENEDICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR # 11126
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR # 11126
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 720-253-0503
  • Fax:
Mailing address:
  • Phone: 720-253-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704015875
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: