Benjamin K Bentley, LCAS, LCMHCS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4754 Issued in NC

Practice address

6614 Shallowford Rd Ste 250
Lewisville, NC 27023-9305

Phone

(336) 945-0137

Fax

(336) 946-9084

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 10, 2024 through May 10, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ben Bentley Counseling PLLC

  • Mental Health Counselor
  • Winston Salem, NC
  • NPI 1902760648
  NPD Authorized official
• Mood Treatment Center, PLLC

  • Psychiatry Physician
  • Winston Salem, NC
  • NPI 1285867952
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1013920784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5335 ROBINHOOD VILLAGE DR STE 155",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271069820",
            "telephone_number": "336-905-9532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6614 SHALLOWFORD RD STE 250",
            "city": "LEWISVILLE",
            "state": "NC",
            "postal_code": "270239305",
            "telephone_number": "336-945-0137",
            "fax_number": "336-946-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTLEY",
        "first_name": "BENJAMIN",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "LCAS, LCMHCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "685",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "4754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6102194",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• A Grounded Path Wellness, PLLC
• Michael Anderson, MS OTR/L
• Anne Marie Asbill, PT, DPT
• Keisha T Banks, LCSW
• Anabela Barreto, PA-C
• Connie Lynn Marie Bigwood, DPT
• Yvette Ramirez Boland, M.A., CCC-SLP
• Stephen Lee Bower, M.D.
• Lindsay Bowser, MS, CCC-SLP
• Jessica Marie Azcarate Branower, MSM, MMS, PA-C

• Professional Counselor in Lewisville, NC
• Providers in Lewisville, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.