Provider Demographics
NPI:1144045857
Name:MASON, BENITA J (NC CERTIFIED PEER SU)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:J
Last Name:MASON
Suffix:
Gender:F
Credentials:NC CERTIFIED PEER SU
Other - Prefix:
Other - First Name:BENITA
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7422 SADDLE TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6141
Mailing Address - Country:US
Mailing Address - Phone:919-730-8840
Mailing Address - Fax:
Practice Address - Street 1:7422 SADDLE TRAIL LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6141
Practice Address - Country:US
Practice Address - Phone:919-730-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 171M00000X
NC2024-12692-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator