Provider Demographics
NPI:1720771827
Name:COGGINS, BENJAMIN L (CADC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:L
Last Name:COGGINS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7349 STATESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3702
Mailing Address - Country:US
Mailing Address - Phone:866-797-7962
Mailing Address - Fax:
Practice Address - Street 1:7349 STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3702
Practice Address - Country:US
Practice Address - Phone:866-797-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCCADC-16493101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)