Provider Demographics
NPI:1275070062
Name:BENSON, ELLAYNNA
Entity type:Individual
Prefix:
First Name:ELLAYNNA
Middle Name:
Last Name:BENSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1148
Mailing Address - Country:US
Mailing Address - Phone:510-753-0258
Mailing Address - Fax:510-878-7345
Practice Address - Street 1:1005 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1148
Practice Address - Country:US
Practice Address - Phone:510-753-0258
Practice Address - Fax:510-878-7345
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor