Provider Demographics
NPI:1801202296
Name:HENRY, JOHN A JR (MDIV MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:HENRY
Suffix:JR
Gender:M
Credentials:MDIV MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2156
Mailing Address - Country:US
Mailing Address - Phone:919-949-7701
Mailing Address - Fax:
Practice Address - Street 1:717 GREEN VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2156
Practice Address - Country:US
Practice Address - Phone:919-949-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health