Provider Demographics
NPI:1841619525
Name:HENRY, LISA KAY (LPCA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 PISGAH CHURCH RD # 234
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2590
Mailing Address - Country:US
Mailing Address - Phone:336-268-7700
Mailing Address - Fax:
Practice Address - Street 1:415 PISGAH CHURCH RD # 234
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2590
Practice Address - Country:US
Practice Address - Phone:336-268-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10699101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor