Provider Demographics
NPI:1508222175
Name:BENISH, CANDY SUE (LMBT)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:SUE
Last Name:BENISH
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 CHILHAM PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3000
Mailing Address - Country:US
Mailing Address - Phone:704-292-8056
Mailing Address - Fax:
Practice Address - Street 1:3349 CHILHAM PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3000
Practice Address - Country:US
Practice Address - Phone:704-292-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X, 174400000X
NC8937225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937OtherNC BOARD OF MASSAGE & BODYWORK THERAPY