Individual
BENICIA ELAINE CLEVELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, LAT, ATC
Contact information
Practice address
1250 S MARTIN LUTHER KING JR. DRIVE, WINSTON-SALEM STATE UNIVERSITY, WINSTON-SALEM, NC 27107
(336) 750-2597
(336) 750-8880
Mailing address
1250 S MARTIN LUTHER KING JR. DRIVE, WINSTON-SALEM STATE UNIVERSITY, WINSTON-SALEM, NC 27107
(336) 750-2597
(336) 750-8880
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1231
NC
Other
Enumeration date
04/23/2009
Last updated
09/13/2011
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