Provider Demographics
NPI:1497417018
Name:HENSLEY, MARY ANN (EDD, LPC, RPT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:EDD, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11434 JASPER KAY TER UNIT 1114
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5528
Mailing Address - Country:US
Mailing Address - Phone:706-459-7742
Mailing Address - Fax:
Practice Address - Street 1:11434 JASPER KAY TER UNIT 1114
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5528
Practice Address - Country:US
Practice Address - Phone:706-459-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011422101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor