Healthcare Provider Details

I. General information

NPI: 1407227309
Provider Name (Legal Business Name): HENNING AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2015
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 PHILADELPHIA CHURCH RD
DALLAS NC
28034-7684
US

IV. Provider business mailing address

1002 PHILADELPHIA CHURCH RD
DALLAS NC
28034-7684
US

V. Phone/Fax

Practice location:
  • Phone: 704-923-8360
  • Fax: 704-923-8364
Mailing address:
  • Phone: 704-923-8360
  • Fax: 704-923-8364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21100.320
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP009324
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK HAYNES HENNING
Title or Position: CEO
Credential:
Phone: 704-923-8360