Provider Demographics
NPI:1790977288
Name:MCHENRY, QYTRICE R (CDP)
Entity Type:Individual
Prefix:
First Name:QYTRICE
Middle Name:R
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:QYRICE
Other - Middle Name:R
Other - Last Name:ROUINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDP
Mailing Address - Street 1:3629 S D ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-6813
Mailing Address - Country:US
Mailing Address - Phone:253-798-3591
Mailing Address - Fax:253-798-2935
Practice Address - Street 1:3629 S D ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418
Practice Address - Country:US
Practice Address - Phone:253-798-3591
Practice Address - Fax:253-798-2935
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)