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General NPI Number Information
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NPI Number | 1023110806
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Entity Type | Individual
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Provider Name | SOPHIA L HENRY LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 12/09/2007
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Provider Practice Location Address
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Address Line | 60 11TH ST NE
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City | ATLANTA
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State | GA
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Zip | 30309-3970
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Country | US
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Telephone | 404-892-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 114 NEW ST SUITE G4
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City | DECATUR
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State | GA
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Zip | 30030-4132
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Country | US
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Telephone | 404-925-2957
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Fax | 770-882-7132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003618
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License Number State | GA
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