Healthcare Provider Details

I. General information

NPI: 1245422062
Provider Name (Legal Business Name): ANTHONY H HENLEY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUITE 102
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

2327 40TH ST NW APT. 1
WASHINGTON DC
20007-1754
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax:
Mailing address:
  • Phone: 202-248-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: