Provider Demographics
NPI:1447021522
Name:HENRY, HALLIE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32297 BRANDON PL
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2547
Mailing Address - Country:US
Mailing Address - Phone:440-263-3800
Mailing Address - Fax:
Practice Address - Street 1:32297 BRANDON PL
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2547
Practice Address - Country:US
Practice Address - Phone:440-263-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0178161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical