Provider Demographics
NPI:1285455402
Name:HENRY, ASHANTI
Entity type:Individual
Prefix:
First Name:ASHANTI
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-4146
Mailing Address - Country:US
Mailing Address - Phone:321-365-1774
Mailing Address - Fax:
Practice Address - Street 1:5830 US HIGHWAY 1 STE 104
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5704
Practice Address - Country:US
Practice Address - Phone:321-609-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician