Provider Demographics
NPI:1699145797
Name:BENJAMIN, DILUCKSHI
Entity type:Individual
Prefix:
First Name:DILUCKSHI
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CASS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-8803
Mailing Address - Country:US
Mailing Address - Phone:586-212-8218
Mailing Address - Fax:586-408-6485
Practice Address - Street 1:117 CASS AVE STE 205
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-8803
Practice Address - Country:US
Practice Address - Phone:586-212-8218
Practice Address - Fax:586-408-6485
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional