MEDICARE: DR. JESSICA HENRY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY200001310	DC

General Provider Information

NPI Number	:	1205313954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA HENRY PHD

Provider Business Mailing Address
First Line	:	UNITY HEALTH CARE, INC.
Second Line	:	1100 NEW JERSEY AVENUE SE SUITE 500
City	:	WASHINGTON
State	:	DC
Zip	:	20003
Country	:	US
Telephone Number	:	202-469-4699
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 N DRUID HILLS RD NE STE 132
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3118
Country	:	US
Telephone Number	:	703-861-9165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	03/30/2022

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