Provider Demographics
NPI:1184010902
Name:HENRY, PRENTISS (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:PRENTISS
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6534 OVERLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9691
Mailing Address - Country:US
Mailing Address - Phone:480-747-1189
Mailing Address - Fax:
Practice Address - Street 1:6534 OVERLAND PARK DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9691
Practice Address - Country:US
Practice Address - Phone:480-747-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health