Provider Demographics
NPI:1992837058
Name:MANNING, BENJAMIN JACOBS (MSW, LCAS, LCSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JACOBS
Last Name:MANNING
Suffix:
Gender:M
Credentials:MSW, LCAS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SHIPYARD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6431
Mailing Address - Country:US
Mailing Address - Phone:919-360-7247
Mailing Address - Fax:
Practice Address - Street 1:165 SHIPYARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6431
Practice Address - Country:US
Practice Address - Phone:919-360-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1148101YA0400X
NCC0059311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007254Medicaid
14742OtherBCBSNC
NC6007254Medicaid