Provider Demographics
NPI:1295318079
Name:HENLY, SHEA CECIL (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SHEA
Middle Name:CECIL
Last Name:HENLY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 CHAMPLAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2795
Mailing Address - Country:US
Mailing Address - Phone:202-540-9857
Mailing Address - Fax:202-232-8494
Practice Address - Street 1:2155 CHAMPLAIN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2795
Practice Address - Country:US
Practice Address - Phone:202-540-9857
Practice Address - Fax:202-232-8494
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2245121041C0700X
DCLC2000013801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical