Provider Demographics
NPI:1669602496
Name:GIVENS-HENRY, TRINA N (LICSW)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:N
Last Name:GIVENS-HENRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:N
Other - Last Name:GIVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:18397 CHENNAULT WAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1124
Mailing Address - Country:US
Mailing Address - Phone:952-975-0945
Mailing Address - Fax:
Practice Address - Street 1:18397 CHENNAULT WAY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-1124
Practice Address - Country:US
Practice Address - Phone:952-975-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN176051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1841650439Medicaid