Provider Demographics
NPI:1912686486
Name:BENSON, SHANNA (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SHADY SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-4874
Mailing Address - Country:US
Mailing Address - Phone:803-479-5532
Mailing Address - Fax:
Practice Address - Street 1:602 STELLATA DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1905
Practice Address - Country:US
Practice Address - Phone:919-636-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical