MEDICARE: MR. BENJAMIN NEAL MILLSAP MSW, LCSW, LCAS, CCS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1046	NC
2	1041C0700X	Clinical Social Worker	C005395	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629110168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN NEAL MILLSAP MSW, LCSW, LCAS, CCS

Provider Business Mailing Address
First Line	:	350 PEE DEE AVE
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-4932
Country	:	US
Telephone Number	:	704-986-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 PEEDEE AVE
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-4932
Country	:	US
Telephone Number	:	704-986-1554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	12/18/2013

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