Provider Demographics
NPI:1942017785
Name:BENTON-HART, GREYSON E
Entity type:Individual
Prefix:
First Name:GREYSON
Middle Name:E
Last Name:BENTON-HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACIE
Other - Middle Name:E
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5974
Mailing Address - Country:US
Mailing Address - Phone:757-576-9311
Mailing Address - Fax:
Practice Address - Street 1:1525 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5974
Practice Address - Country:US
Practice Address - Phone:757-576-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-24-399521106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician