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General NPI Number Information
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NPI Number | 1609074111
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Entity Type | Individual
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Provider Name | MELISSA KELLY BENSON LCSW, LCAS
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Gender | Female
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1337 E GARRISON BLVD
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City | GASTONIA
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State | NC
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Zip | 28054-5127
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Country | US
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Telephone | 704-865-3848
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Fax | 704-854-3086
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Provider Business Mailing Address
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Address Line | PO BOX 744786
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City | ATLANTA
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State | GA
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Zip | 30374-4786
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Country | US
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Telephone | 48-342-4507
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Fax | 704-671-5531
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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 | 1025
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C00046
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License Number State | NC
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