Provider Demographics
NPI:1376921320
Name:HENSLEY, SAMUEL (LCAS)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PICKENS LN
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9321
Mailing Address - Country:US
Mailing Address - Phone:850-380-9066
Mailing Address - Fax:828-484-8463
Practice Address - Street 1:11 PICKENS LN
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9321
Practice Address - Country:US
Practice Address - Phone:850-380-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)