Provider Demographics
NPI:1225375413
Name:BENJAMIN-CARTER, CHARNELL (LMHC)
Entity type:Individual
Prefix:
First Name:CHARNELL
Middle Name:
Last Name:BENJAMIN-CARTER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 BOGGY MOSS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-9503
Mailing Address - Country:US
Mailing Address - Phone:813-205-0079
Mailing Address - Fax:
Practice Address - Street 1:10305 BOGGY MOSS DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-9503
Practice Address - Country:US
Practice Address - Phone:813-205-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
FLMH-17419101YM0800X
FLMH17419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171W00000XOther Service ProvidersContractor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB525100736800OtherDRIVER LICENSE NUMBER
FLC636-102-73-680-0OtherDRIVER LICENSE NUMBER