Provider Demographics
NPI:1780605493
Name:BENBOW, KATHERINE D (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:BENBOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 BRIDLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9500
Mailing Address - Country:US
Mailing Address - Phone:704-788-1844
Mailing Address - Fax:
Practice Address - Street 1:4208 SIX FORKS RD
Practice Address - Street 2:BLDG 1, SUITE 305A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5735
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002052101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106316Medicaid
NC6106316Medicaid