Provider Demographics
NPI:1477998797
Name:BENTHALL, DAPHNE FAYE (LCASA)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:FAYE
Last Name:BENTHALL
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-1824
Mailing Address - Country:US
Mailing Address - Phone:252-308-2470
Mailing Address - Fax:
Practice Address - Street 1:5013 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7045
Practice Address - Country:US
Practice Address - Phone:910-796-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)