Provider Demographics
NPI:1205852530
Name:HENSON, ROBERT L (CAC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HENSON
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 RODERICK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-2247
Mailing Address - Country:US
Mailing Address - Phone:985-380-2455
Mailing Address - Fax:985-380-2470
Practice Address - Street 1:512 RODERICK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-2247
Practice Address - Country:US
Practice Address - Phone:985-380-2455
Practice Address - Fax:985-380-2470
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)