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General NPI Number Information
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NPI Number | 1982288916
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Entity Type | Individual
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Provider Name | CASSONIA HENLEY
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Gender | Female
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 3643 WALTON WAY EXT BLDG 4
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City | AUGUSTA
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State | GA
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Zip | 30909-6677
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Country | US
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Telephone | 706-364-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 WOODCREST DR APT H
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City | AUGUSTA
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State | GA
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Zip | 30909-0413
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Country | US
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Telephone | 706-814-0869
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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