Doctor Name: | MS. CONNIE JEAN HENZE |
NPI Number: | 1841535648 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, CADC-M |
License Number: | |
Business Practice Address: | 11301 E Denver Rd Coleman, MI - 486189631 |
Business Phone Number: | 3133196362 |
Business Fax Number: | |
Mailing Address: | 11301 E Denver Rd, COLEMAN |
State: | MI |
Postal Code: | 486189631 |
Phone Number: | 3133196362 |
Fax Number: | |
NPI Enumeration Date: | 12/05/2012 |
NPI Last Update Date: | 12/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |