Provider Demographics
NPI:1770687865
Name:HENSON, KIM A (LCADC MAC)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:A
Last Name:HENSON
Suffix:
Gender:M
Credentials:LCADC MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BEDFORD STREET
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2304
Mailing Address - Country:US
Mailing Address - Phone:301-722-8000
Mailing Address - Fax:301-722-8001
Practice Address - Street 1:152 BEDFORD STREET
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2304
Practice Address - Country:US
Practice Address - Phone:301-722-8000
Practice Address - Fax:301-722-8001
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)