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General NPI Number Information
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NPI Number | 1073039319
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Entity Type | Organization
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Legal Business Name | SUE HENRICKSON LMHC LLC
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 08/18/2017
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Provider Practice Location Address
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Address Line | 285 CENTRAL ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-6144
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Country | US
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Telephone | 978-505-1791
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Fax |
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Provider Business Mailing Address
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Address Line | 63 RUSSELL HILL RD
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City | ASHBURNHAM
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State | MA
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Zip | 01430
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Country | US
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Telephone | 978-505-1791
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUE HENRICKSON
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Credential | LMHC
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Telephone | 978-505-1791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 7813
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License Number State | MA
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