MEDICARE: LISA KAY HENRY LPCA

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	101Y00000X	Counselor	A10699	NC

General Provider Information

NPI Number	:	1841619525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KAY HENRY LPCA

Provider Business Mailing Address
First Line	:	415 PISGAH CHURCH RD # 234
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2590
Country	:	US
Telephone Number	:	336-268-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 PISGAH CHURCH RD # 234
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2590
Country	:	US
Telephone Number	:	336-268-7700
Fax Number	:

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

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/10/2014

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