Provider Demographics
NPI:1396249496
Name:BENSON, GLORIA A (CDC 1)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:BENSON
Suffix:
Gender:F
Credentials:CDC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:YAKUTAT
Mailing Address - State:AK
Mailing Address - Zip Code:99689-0112
Mailing Address - Country:US
Mailing Address - Phone:907-784-3275
Mailing Address - Fax:907-784-3263
Practice Address - Street 1:712 OCEAN CAPE RD
Practice Address - Street 2:
Practice Address - City:YAKUTAT
Practice Address - State:AK
Practice Address - Zip Code:99689
Practice Address - Country:US
Practice Address - Phone:907-784-3275
Practice Address - Fax:907-784-3263
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)