Provider Demographics
NPI:1285165910
Name:HENSON, MERENCIA NOLINDA
Entity type:Individual
Prefix:
First Name:MERENCIA
Middle Name:NOLINDA
Last Name:HENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERENCIA
Other - Middle Name:NOLINDA
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3665 KEARNY VILLA RD STE 165
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1954
Mailing Address - Country:US
Mailing Address - Phone:619-818-7359
Mailing Address - Fax:
Practice Address - Street 1:3665 KEARNY VILLA RD STE 165
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1954
Practice Address - Country:US
Practice Address - Phone:619-818-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA928591041C0700X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical