Provider Demographics
NPI:1053959619
Name:COLON, BENLYD (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:BENLYD
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 QUEEN ANNE LOOP APT 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7899
Mailing Address - Country:US
Mailing Address - Phone:910-578-7816
Mailing Address - Fax:
Practice Address - Street 1:2940 BREEZEWOOD AVE STE 101-201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5520
Practice Address - Country:US
Practice Address - Phone:910-827-6594
Practice Address - Fax:910-827-6592
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0142551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical