Provider Demographics
NPI:1710672951
Name:HENSON, JAMES (SUD MASTERS DEGREE)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HENSON
Suffix:
Gender:M
Credentials:SUD MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19211 ANGLIN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1460
Mailing Address - Country:US
Mailing Address - Phone:313-263-0077
Mailing Address - Fax:
Practice Address - Street 1:19211 ANGLIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1460
Practice Address - Country:US
Practice Address - Phone:313-263-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)