Provider Demographics
NPI:1598019226
Name:BENTLEY, FALISHA NICOLE
Entity Type:Individual
Prefix:MISS
First Name:FALISHA
Middle Name:NICOLE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19627 RIDGEMONT ST
Mailing Address - Street 2:UNIT #14
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3320
Mailing Address - Country:US
Mailing Address - Phone:586-709-1111
Mailing Address - Fax:
Practice Address - Street 1:19627 RIDGEMONT ST
Practice Address - Street 2:UNIT #14
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3320
Practice Address - Country:US
Practice Address - Phone:586-709-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)