Provider Demographics
NPI:1689845984
Name:BENTON, ADRIANA (MS, MFTI)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 GREEN RIVER RD
Mailing Address - Street 2:101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7426
Mailing Address - Country:US
Mailing Address - Phone:951-279-3222
Mailing Address - Fax:951-279-5222
Practice Address - Street 1:2791 GREEN RIVER RD
Practice Address - Street 2:101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7426
Practice Address - Country:US
Practice Address - Phone:951-279-3222
Practice Address - Fax:951-279-5222
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 52134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health