Provider Demographics
NPI:1740080068
Name:HENRY, BASHAUN JAKIA (MSW)
Entity type:Individual
Prefix:MRS
First Name:BASHAUN
Middle Name:JAKIA
Last Name:HENRY
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8487
Mailing Address - Country:US
Mailing Address - Phone:850-544-2599
Mailing Address - Fax:
Practice Address - Street 1:20311 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1947
Practice Address - Country:US
Practice Address - Phone:850-544-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty