Provider Demographics
NPI:1811355118
Name:HENAGAN, LEANETTE (DBH LCSW, LISAC)
Entity type:Individual
Prefix:DR
First Name:LEANETTE
Middle Name:
Last Name:HENAGAN
Suffix:
Gender:F
Credentials:DBH LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 W PEORIA AVE
Mailing Address - Street 2:STE 102-429
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5212
Mailing Address - Country:US
Mailing Address - Phone:602-469-9040
Mailing Address - Fax:
Practice Address - Street 1:3039 W PEORIA AVE
Practice Address - Street 2:STE 102-429
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5212
Practice Address - Country:US
Practice Address - Phone:602-469-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11452101YA0400X
AZLCSW-136211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)