Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 8975 | CA |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 182820120 | CA |
Y | 101YM0800X | Mental Health Counselor | 8975 | CA |
N | 101YP1600X | Pastoral Counselor | 8975 | CA |
NPI | 1073128559 |
---|---|
Provider Name | Dr. Willie Benson |
First Address | La Mesa, CA 91942-0524 |
Second Address | La Mesa, CA 91942-0524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2020 |
Last Update Date | 14/09/2020 |