Organization
SOUTHEASTERN PSYCHIATRIC PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN DONALDSON PA-C (OWNER/AUTHORIZED)
(408) 364-6160
Entity
Organization
Contact information
Practice address
2050 MERCANTILE DR APT C9, LELAND, NC 28451-4053
(910) 370-2500
Mailing address
PO BOX 3516, WILMINGTON, NC 28406-0516
(408) 364-6160
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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