Healthcare Provider Details

I. General information

NPI: 1043408347
Provider Name (Legal Business Name): HENRY H KNIGHT JR. LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 12/14/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CARVER RD
WEST WAREHAM MA
02576-1226
US

IV. Provider business mailing address

118 HIGHLAND SHORES DR
WAREHAM MA
02571-1355
US

V. Phone/Fax

Practice location:
  • Phone: 774-247-0087
  • Fax: 508-295-4551
Mailing address:
  • Phone: 508-295-4551
  • Fax: 508-295-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6395
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: