Doctor Name: | MRS. MELANIE MARIE HENSON |
NPI Number: | 1295054393 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LPC005363 |
Business Practice Address: | 410 East Church Street Fort Valley, GA - 31030 |
Business Phone Number: | 4788256499 |
Business Fax Number: | 4788252160 |
Mailing Address: | 940 Highway 96, WARNER ROBINS |
State: | GA |
Postal Code: | 31088 |
Phone Number: | 4789881222 |
Fax Number: | 4789881050 |
NPI Enumeration Date: | 05/28/2010 |
NPI Last Update Date: | 02/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC005363 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |