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General NPI Number Information
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NPI Number | 1740107648
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Entity Type | Individual
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Provider Name | DEMETREE BENTON
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Gender | Female
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 8929 J M KEYNES DR # 330E
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City | CHARLOTTE
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State | NC
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Zip | 28262-8406
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Country | US
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Telephone | 704-900-7488
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Fax | 855-583-7047
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Provider Business Mailing Address
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Address Line | 8929 J M KEYNES DR # 330E
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City | CHARLOTTE
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State | NC
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Zip | 28262-8406
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Country | US
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Telephone | 704-900-7488
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Fax | 855-583-7047
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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