Provider Demographics
NPI:1336842483
Name:HENRY, CAITLIN DONNA
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:DONNA
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6670 FOX DEN RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3465
Mailing Address - Country:US
Mailing Address - Phone:571-329-7213
Mailing Address - Fax:
Practice Address - Street 1:8530 CINDER BED RD STE 1300
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1478
Practice Address - Country:US
Practice Address - Phone:703-782-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst