Provider Demographics
NPI:1609171297
Name:HENRY, LUEVINA
Entity Type:Individual
Prefix:
First Name:LUEVINA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N MAIN ST
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1409
Mailing Address - Country:US
Mailing Address - Phone:951-738-2400
Mailing Address - Fax:951-340-3566
Practice Address - Street 1:629 N.MAIN ST.
Practice Address - Street 2:SUITE C-3
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880
Practice Address - Country:US
Practice Address - Phone:951-738-2400
Practice Address - Fax:951-340-3566
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health