Provider Demographics
NPI:1598960825
Name:HENRY, GWENDOLYN (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GWENDOLYN HOWELL
Mailing Address - Street 1:16719 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4257
Mailing Address - Country:US
Mailing Address - Phone:479-586-3349
Mailing Address - Fax:
Practice Address - Street 1:16719 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4257
Practice Address - Country:US
Practice Address - Phone:501-500-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA801004101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5BD81OtherBLUE CROSS BLUE SHIELD
AR1598960825OtherNPPES