Individual
KELLY WILSON BENJAMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1821 PICKENS ST, COLUMBIA, SC 29201-2630
(803) 622-4458
Mailing address
380 CANAL PLACE DR, COLUMBIA, SC 29201-1556
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6522
SC
101YM0800X
Mental Health Counselor
7045
SC
101YP2500X
Professional Counselor
6522
SC
101YP2500X
Professional Counselor
Primary
7045
SC
Other
Enumeration date
11/29/2017
Last updated
02/03/2019
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