Provider Demographics
NPI:1194618496
Name:BOONE, BENJAMIN JR (MSW,LCSWA,LCASA)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:BOONE
Suffix:JR
Gender:M
Credentials:MSW,LCSWA,LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 YELLOW BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7433
Mailing Address - Country:US
Mailing Address - Phone:718-964-7267
Mailing Address - Fax:
Practice Address - Street 1:249 NC-54 STE 320,
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701
Practice Address - Country:US
Practice Address - Phone:919-907-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29395101YA0400X
NCPO20196101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)