Provider Demographics
NPI:1912620063
Name:HENRY, JAMES CULBREATH
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CULBREATH
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 S ECONLOCKHATCHEE TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8032
Mailing Address - Country:US
Mailing Address - Phone:813-743-2804
Mailing Address - Fax:
Practice Address - Street 1:663 S ECONLOCKHATCHEE TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8032
Practice Address - Country:US
Practice Address - Phone:813-743-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-234952106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician