Provider Demographics
NPI:1043619596
Name:BENITEZ, ELBA CAROLINA (PHD, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:CAROLINA
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:DR
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC, NCC
Mailing Address - Street 1:7200 E WT HARRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7200
Mailing Address - Country:US
Mailing Address - Phone:704-426-9724
Mailing Address - Fax:704-531-4068
Practice Address - Street 1:6050 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4130
Practice Address - Country:US
Practice Address - Phone:704-426-9724
Practice Address - Fax:704-531-4068
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional