Provider Demographics
NPI:1710553169
Name:HENSON, ALEXA (NCC, LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:NCC, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1834
Mailing Address - Country:US
Mailing Address - Phone:336-782-5770
Mailing Address - Fax:
Practice Address - Street 1:3336 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1834
Practice Address - Country:US
Practice Address - Phone:336-782-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health