| Doctor Name: | MR. STEPHEN WILLIAM HENNEKA |
| NPI Number: | 1104916428 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.S.W. |
| License Number: | SW0002939 |
| Business Practice Address: | 1100 S Ponce De Leon Blvd Ste 1 Saint Augustine, FL - 320846013 |
| Business Phone Number: | 9048247733 |
| Business Fax Number: | 9048299768 |
| Mailing Address: | 1100 S Ponce De Leon Blvd Ste 1, SAINT AUGUSTINE |
| State: | FL |
| Postal Code: | 320846013 |
| Phone Number: | 9048247733 |
| Fax Number: | 9048299768 |
| NPI Enumeration Date: | 10/15/2006 |
| NPI Last Update Date: | 01/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | SW0002939 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |