Provider Demographics
NPI:1982825600
Name:HENRY-WILSON, CAROLYN (BA, ICAC-II, MATS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HENRY-WILSON
Suffix:
Gender:F
Credentials:BA, ICAC-II, MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13861 WENDESSA DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-6681
Mailing Address - Country:US
Mailing Address - Phone:317-727-2860
Mailing Address - Fax:
Practice Address - Street 1:1810 BROAD RIPPLE AVE
Practice Address - Street 2:STE. 1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2363
Practice Address - Country:US
Practice Address - Phone:317-251-8550
Practice Address - Fax:317-251-8611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)