MEDICARE: BENEVOLENT COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1538632518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEVOLENT COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	75 GROVER PL
Second Line	:
City	:	CAMERON
State	:	NC
Zip	:	28326-6210
Country	:	US
Telephone Number	:	910-824-3865
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 BREEZEWOOD AVE STE 201
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5464
Country	:	US
Telephone Number	:	910-568-5122
Fax Number	:	910-312-3569

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	LEISA K COOK
Credential	:	MS, LCMHC
Telephone Number	:	910-568-5122

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	08/12/2024

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