Healthcare Provider Details

I. General information

NPI: 1811077316
Provider Name (Legal Business Name): DONALD HENCK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 THREE QUARTER POINT RD
WIRTZ VA
24184
US

IV. Provider business mailing address

773 THREE QUARTER POINT RD
WIRTZ VA
24184
US

V. Phone/Fax

Practice location:
  • Phone: 804-240-2874
  • Fax:
Mailing address:
  • Phone: 804-240-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701000685
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: