Provider Demographics
NPI:1841088952
Name:HENRICHS, ANNABELLA AUTUMN
Entity type:Individual
Prefix:
First Name:ANNABELLA
Middle Name:AUTUMN
Last Name:HENRICHS
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 1:4150 S WASHINGTON ST APT 326
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3259
Mailing Address - Country:US
Mailing Address - Phone:218-556-3598
Mailing Address - Fax:
Practice Address - Street 1:203 14TH ST NE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1626
Practice Address - Country:US
Practice Address - Phone:218-693-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health