| Doctor Name: | MS. MIRA DENISE HENRY |
| NPI Number: | 1013037654 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | |
| Business Practice Address: | 115 Doctors Park Lincolnton, NC - 280924407 |
| Business Phone Number: | 7047352441 |
| Business Fax Number: | |
| Mailing Address: | 2356 E Maiden Rd, MAIDEN |
| State: | NC |
| Postal Code: | 286508527 |
| Phone Number: | 8284288814 |
| Fax Number: | |
| NPI Enumeration Date: | 03/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TM1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Mental Retardation & Developmental Disabilities |
| Taxonomy Definition: | |