Basic Information
| Provider Information | |||||||||
| NPI: | 1598021214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | GIOVANNA | ||||||||
| MiddleName: | GONZALEZ | ||||||||
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| Credential: | P-LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 WILLOW LN | ||||||||
| Address2: | WEST PARK C61-2 | ||||||||
| City: | N WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366675151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2012 | ||||||||
| LastUpdateDate: | 04/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.