Provider Demographics
NPI:1962834960
Name:GAY, BENITA ANN (MSED)
Entity Type:Individual
Prefix:MS
First Name:BENITA
Middle Name:ANN
Last Name:GAY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:BENITA
Other - Middle Name:ANN
Other - Last Name:ROLLINS-GAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:1205 W DUBLIN ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1424
Mailing Address - Country:US
Mailing Address - Phone:217-766-7561
Mailing Address - Fax:
Practice Address - Street 1:202 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3929
Practice Address - Country:US
Practice Address - Phone:217-693-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor