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General NPI Number Information
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NPI Number | 1114682549
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Entity Type | Organization
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Legal Business Name | OAK CITY PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 8410 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-3079
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Country | US
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Telephone | 919-234-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 8410 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-3079
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Country | US
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Telephone | 919-234-7247
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLEY L BENTON
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Credential | PSY.D.
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Telephone | 919-234-7247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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