Provider Demographics
NPI:1851433676
Name:HENN, ANGELA D
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:HENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 PONTE VEDRA PARK DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-6613
Mailing Address - Country:US
Mailing Address - Phone:904-280-0081
Mailing Address - Fax:
Practice Address - Street 1:228 PONTE VEDRA PARK DR
Practice Address - Street 2:SUITE 800
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6613
Practice Address - Country:US
Practice Address - Phone:904-280-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor