Provider Demographics
NPI:1134696875
Name:HENSLEY, PATRICIA IRENE (CDCA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:IRENE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:IRENE
Other - Last Name:FAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDCA
Mailing Address - Street 1:47 SUTTON LANE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122
Mailing Address - Country:US
Mailing Address - Phone:937-768-3934
Mailing Address - Fax:
Practice Address - Street 1:338 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1314
Practice Address - Country:US
Practice Address - Phone:937-768-3934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.168218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)