Provider Demographics
NPI:1023901741
Name:BENTON, JASMINE (MAED, LCMHCA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:MAED, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 SIRIUS DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-8500
Mailing Address - Country:US
Mailing Address - Phone:704-438-4827
Mailing Address - Fax:
Practice Address - Street 1:2520 TROY DR # 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7661
Practice Address - Country:US
Practice Address - Phone:910-762-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health