Provider Demographics
NPI:1023110806
Name:HENRY, SOPHIA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:L
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 NEW ST
Mailing Address - Street 2:SUITE G4
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4132
Mailing Address - Country:US
Mailing Address - Phone:404-925-2957
Mailing Address - Fax:770-882-7132
Practice Address - Street 1:60 11TH ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3970
Practice Address - Country:US
Practice Address - Phone:404-892-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical