Provider Demographics
NPI:1871090167
Name:FAITH BASED COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:FAITH BASED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LA'NEIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENBOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MFT
Authorized Official - Phone:252-493-6300
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590
Mailing Address - Country:US
Mailing Address - Phone:252-493-6300
Mailing Address - Fax:252-493-6300
Practice Address - Street 1:235 COMMERECE STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-493-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10548101YA0400X
NCC007676104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty