Healthcare Provider Details

I. General information

NPI: 1346162138
Provider Name (Legal Business Name): MATTHEW HENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 DAUPHIN ST
MOBILE AL
36604-1307
US

IV. Provider business mailing address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

V. Phone/Fax

Practice location:
  • Phone: 251-202-3019
  • Fax:
Mailing address:
  • Phone: 251-202-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberALC06108
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: