Provider Information for 1821579806
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CONSUELA MARIA HENRY LCSW
Sex: Female
NPI: 1821579806
Last Updated: 2023-07-10
Certification Date: 2023-07-10
Certification Date: 2023-07-10
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1821579806 | ||||||||||||
| Enumeration Date | 2018-08-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 118 CUTTER GAP SE LUDOWICI, GA 31316-3104 United States Phone: 706-627-4690 | Fax: | ||||||||||||
| Primary Practice Address | 118 CUTTER GAP SE LUDOWICI, GA 31316-3104 United States Phone: 678-591-4474 | Fax: | ||||||||||||
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