Provider Demographics
NPI:1982937207
Name:BENJAMIN, ANNETTA SERENA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANNETTA
Middle Name:SERENA
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LPC
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Other - First Name:
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Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5698
Mailing Address - Country:US
Mailing Address - Phone:703-330-9933
Mailing Address - Fax:703-368-8454
Practice Address - Street 1:12721 DARBY BROOK CT
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2408
Practice Address - Country:US
Practice Address - Phone:703-497-1771
Practice Address - Fax:703-497-1225
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701004674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health