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General NPI Number Information
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NPI Number | 1285223925
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Entity Type | Individual
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Provider Name | MICHAEL PATRICK HENRY LCSWA, LCASA
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Gender | Male
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 2101 GARNER RD
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City | RALEIGH
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State | NC
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Zip | 27610-0114
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Country | US
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Telephone | 919-787-6131
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Fax | 919-571-2932
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Provider Business Mailing Address
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Address Line | 3125 POPLARWOOD CT STE 203
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City | RALEIGH
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State | NC
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Zip | 27604-6445
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Country | US
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Telephone | 919-787-6131
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Fax | 919-571-2932
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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 | P019247
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-30800
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License Number State | NC
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