Provider Demographics
NPI:1396187704
Name:BENTON, AMBER B (MA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:B
Last Name:BENTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102B S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2118
Mailing Address - Country:US
Mailing Address - Phone:919-215-0726
Mailing Address - Fax:
Practice Address - Street 1:102B S 12TH ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2118
Practice Address - Country:US
Practice Address - Phone:919-215-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health