Provider Demographics
NPI:1225660079
Name:BENTON, CHRISTINE ELAINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:BENTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 N ILLINOIS ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1524
Mailing Address - Country:US
Mailing Address - Phone:618-207-1398
Mailing Address - Fax:618-207-1398
Practice Address - Street 1:4509 N ILLINOIS ST STE 5
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1524
Practice Address - Country:US
Practice Address - Phone:618-207-1398
Practice Address - Fax:618-207-1398
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty