Provider Demographics
NPI:1477128536
Name:BENSON, OLIVIA JUSTYNE (LPCMH)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:JUSTYNE
Last Name:BENSON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 ARMSTRONG CORNER ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709
Mailing Address - Country:US
Mailing Address - Phone:302-279-0790
Mailing Address - Fax:
Practice Address - Street 1:817 ROGER CHAFFEE SQ
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-6856
Practice Address - Country:US
Practice Address - Phone:302-279-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X
DEPC-0011449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)