Provider Demographics
NPI:1841535648
Name:HENZE, CONNIE JEAN (MA, CADC-M)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:JEAN
Last Name:HENZE
Suffix:
Gender:F
Credentials:MA, CADC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 E DENVER RD
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-9631
Mailing Address - Country:US
Mailing Address - Phone:313-319-6362
Mailing Address - Fax:
Practice Address - Street 1:11301 E DENVER RD
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:MI
Practice Address - Zip Code:48618-9631
Practice Address - Country:US
Practice Address - Phone:313-319-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)