Provider Demographics
NPI:1598449696
Name:BENYA, AHMADU UMARR
Entity Type:Individual
Prefix:
First Name:AHMADU
Middle Name:UMARR
Last Name:BENYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13207 SHAWNEE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-9505
Mailing Address - Country:US
Mailing Address - Phone:240-423-4775
Mailing Address - Fax:
Practice Address - Street 1:13207 SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-9505
Practice Address - Country:US
Practice Address - Phone:240-423-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB500035824131101Y00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty