Provider Demographics
NPI:1326910233
Name:BETTERSON-DAVIS, BENITA L (LMSW)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:L
Last Name:BETTERSON-DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10328 WHITE BISON CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1265
Mailing Address - Country:US
Mailing Address - Phone:702-858-7443
Mailing Address - Fax:
Practice Address - Street 1:10328 WHITE BISON CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1265
Practice Address - Country:US
Practice Address - Phone:702-858-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6368-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty