Individual
MRS. MICHELLE PHILBROOK BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHCS, LCAS
Contact information
Practice address
209 BARIUM SPRINGS DR, STATESVILLE, NC 28677-8454
(704) 832-5567
Mailing address
PO BOX 1, STATESVILLE, NC 28687-0001
(704) 832-5567
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20476
NC
101YP2500X
Professional Counselor
10290
NC
101YP2500X
Professional Counselor
Primary
S10290
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518272152
—
NC
Enumeration date
08/06/2010
Last updated
04/22/2022
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