Provider Demographics
NPI:1407227309
Name:HENNING AND ASSOCIATES INC
Entity Type:Organization
Organization Name:HENNING AND ASSOCIATES INC
Other - Org Name:ODYSSEY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HAYNES
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-923-8360
Mailing Address - Street 1:1002 PHILADELPHIA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-7684
Mailing Address - Country:US
Mailing Address - Phone:704-923-8360
Mailing Address - Fax:704-923-8364
Practice Address - Street 1:1002 PHILADELPHIA CHURCH RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-7684
Practice Address - Country:US
Practice Address - Phone:704-923-8360
Practice Address - Fax:704-923-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-18
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21100.320101YA0400X
NCP0093241041C0700X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408836Medicaid