Provider Demographics
NPI:1225078512
Name:LINK, HENRY WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:WILLIAM
Last Name:LINK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:302 N. MAIN STREET
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-0329
Mailing Address - Country:US
Mailing Address - Phone:910-628-6718
Mailing Address - Fax:910-628-6719
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-1730
Practice Address - Country:US
Practice Address - Phone:910-628-6718
Practice Address - Fax:910-628-6719
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1614103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000704Medicaid
NC15563900OtherMEGELLAN
NC0384MOtherBC/BS
NC15563900OtherMEGELLAN
NC6000704Medicaid