MEDICARE: CALLINA RENEE HENSON LPC

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	101YP2500X	Professional Counselor	6401008796	MI

General Provider Information

NPI Number	:	1922309814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLINA RENEE HENSON LPC

Provider Business Mailing Address
First Line	:	3080 DIXIE HWY
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48328-1785
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3080 DIXIE HWY
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48328-1785
Country	:	US
Telephone Number	:	248-461-2681
Fax Number	:

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

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	11/08/2010

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