Provider Demographics
NPI:1609520964
Name:HENLEY, HEATHER N (LMHC, CSAYC, NCC,)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:N
Last Name:HENLEY
Suffix:
Gender:F
Credentials:LMHC, CSAYC, NCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 292257
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0038
Mailing Address - Country:US
Mailing Address - Phone:317-985-3631
Mailing Address - Fax:
Practice Address - Street 1:31 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7300
Practice Address - Country:US
Practice Address - Phone:317-985-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8049101YM0800X
IN39003397A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health