Provider Demographics
NPI:1588015119
Name:BENJAMIN, ANTONY (LPC)
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40005 GULLIVER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6932
Mailing Address - Country:US
Mailing Address - Phone:586-216-4877
Mailing Address - Fax:
Practice Address - Street 1:1760 S TELEGRAPH RD STE 220
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0182
Practice Address - Country:US
Practice Address - Phone:586-216-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional