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General NPI Number Information
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NPI Number | 1518272152
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Entity Type | Individual
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Provider Name | MICHELLE PHILBROOK BENTON LCMHCS, LCAS
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Gender | Female
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 209 BARIUM SPRINGS DR
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City | STATESVILLE
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State | NC
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Zip | 28677-8454
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Country | US
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Telephone | 704-832-5567
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1
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City | STATESVILLE
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State | NC
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Zip | 28687-0001
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Country | US
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Telephone | 704-832-5567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20476
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10290
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | S10290
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License Number State | NC
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