Provider Demographics
NPI:1952328601
Name:HENNIG, MARY ANN (LMSW, ACSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:HENNIG
Suffix:
Gender:F
Credentials:LMSW, ACSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6599 GREENE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4419
Mailing Address - Country:US
Mailing Address - Phone:248-408-7735
Mailing Address - Fax:248-625-7470
Practice Address - Street 1:6599 GREENE HAVEN DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4419
Practice Address - Country:US
Practice Address - Phone:248-408-7735
Practice Address - Fax:248-625-7470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010133761041C0700X
MI4101005183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist