Healthcare Provider Details

I. General information

NPI: 1639625510
Provider Name (Legal Business Name): ERIN HENLEY LCSW-C, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 CHESAPEAKE ST NW UNIT B
WASHINGTON DC
20016-4608
US

IV. Provider business mailing address

4116 CHESAPEAKE ST NW UNIT B
WASHINGTON DC
20016-4608
US

V. Phone/Fax

Practice location:
  • Phone: 208-351-1150
  • Fax:
Mailing address:
  • Phone: 208-351-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8806217-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24251
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082523
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: