Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | RI-B0509271001 | CA |
NPI | 1447465976 |
---|---|
Provider Name | Mr. Collins Benye |
First Address | Los Angeles, CA 90034-1342 |
Second Address | Hawthorne, CA 90250-2321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |