Basic Information
| Provider Information | |||||||||
| NPI: | 1215474267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENTLEY | ||||||||
| FirstName: | JULIA | ||||||||
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| Credential: | MS, LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2129 STATESVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281471411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046479491 | ||||||||
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| Practice Location | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2017 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 23106 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.