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General NPI Number Information
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NPI Number | 1669412177
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Entity Type | Organization
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Legal Business Name | SUSAN H MCHENRY
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 13104 POPLAR HILL RD
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City | WALDORF
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State | MD
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Zip | 20601-2048
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Country | US
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Telephone | 301-751-2058
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Fax | 301-632-9595
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Provider Business Mailing Address
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Address Line | 13104 POPLAR HILL RD
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City | WALDORF
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State | MD
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Zip | 20601-2048
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Country | US
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Telephone | 301-751-2058
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Fax | 301-632-9595
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Authorized Official
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Title or Position | OWNER / THERAPIST
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Name | MRS. SUSAN HENDERSON MCHENRY
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Credential | LCSW-C
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Telephone | 301-751-2058
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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 | 10508
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License Number State | MD
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