Healthcare Provider Details

I. General information

NPI: 1235993312
Provider Name (Legal Business Name): MICHAEL PIERRE HENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-3622
US

IV. Provider business mailing address

431 EMERSON ST NW
WASHINGTON DC
20011-6114
US

V. Phone/Fax

Practice location:
  • Phone: 202-459-9866
  • Fax: 888-316-9392
Mailing address:
  • Phone: 202-734-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: