Provider Demographics
NPI:1285315770
Name:HENRY, MOLLY JUSTINE (MS, NBC-HWC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:JUSTINE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 MCCULLOUGH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1662
Mailing Address - Country:US
Mailing Address - Phone:812-552-4053
Mailing Address - Fax:
Practice Address - Street 1:1040 SIERRA DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7240
Practice Address - Country:US
Practice Address - Phone:317-528-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INA-3672999171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach