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General NPI Number Information
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NPI Number | 1205134962
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Entity Type | Organization
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Legal Business Name | BENJAMIN COUNSELING CENTER
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 7614 SHEFFIELD GREEN WAY
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City | LORTON
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State | VA
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Zip | 22079-1710
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Country | US
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Telephone | 703-599-1852
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Fax | 186-666-8453
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Provider Business Mailing Address
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Address Line | 12504 LAKE RIDGE DR SUITE C
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2390
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Country | US
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Telephone | 703-599-1852
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. ANNETTA SERENA BENJAMIN
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Credential | LPC, NCC
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Telephone | 703-599-1852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004674
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License Number State | VA
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