Provider Demographics
NPI:1053485888
Name:HENSLEY, MALCOLM DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:DAVID
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 WILBEC RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6828
Mailing Address - Country:US
Mailing Address - Phone:901-682-7524
Mailing Address - Fax:
Practice Address - Street 1:1440 WILBEC RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6828
Practice Address - Country:US
Practice Address - Phone:901-682-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000044831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical