Provider Demographics
NPI:1346957628
Name:HENNINGER, JANESSA M (PHD, LPC, RPT-S)
Entity Type:Individual
Prefix:DR
First Name:JANESSA
Middle Name:M
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:PHD, LPC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LEIMAMO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3742
Mailing Address - Country:US
Mailing Address - Phone:719-580-8757
Mailing Address - Fax:
Practice Address - Street 1:157 LEIMAMO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3742
Practice Address - Country:US
Practice Address - Phone:719-580-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health