Provider Demographics
NPI:1790025856
Name:HENRY, NYANA MILDRED (LGSW)
Entity Type:Individual
Prefix:
First Name:NYANA
Middle Name:MILDRED
Last Name:HENRY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 TOUCHDOWN DR
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4722
Mailing Address - Country:US
Mailing Address - Phone:301-499-1018
Mailing Address - Fax:301-499-1018
Practice Address - Street 1:501 TOUCHDOWN DR
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4722
Practice Address - Country:US
Practice Address - Phone:301-499-1018
Practice Address - Fax:301-499-1018
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50077783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker