Provider Demographics
NPI:1841177805
Name:BENGE, KATHARINE (EDS)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BENGE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 FOREST HILL AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-4220
Mailing Address - Country:US
Mailing Address - Phone:859-797-4563
Mailing Address - Fax:
Practice Address - Street 1:5437 CRUMPACKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-6022
Practice Address - Country:US
Practice Address - Phone:540-977-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0609311103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool