Provider Demographics
NPI:1306939343
Name:HENRY, CONNIEGAIL G (ND, RN, CADS)
Entity type:Individual
Prefix:DR
First Name:CONNIEGAIL
Middle Name:G
Last Name:HENRY
Suffix:
Gender:F
Credentials:ND, RN, CADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 EDITH BLVD NE UNIT 38
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5090
Mailing Address - Country:US
Mailing Address - Phone:505-343-0552
Mailing Address - Fax:
Practice Address - Street 1:6118 EDITH BLVD NE UNIT 38
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5090
Practice Address - Country:US
Practice Address - Phone:505-343-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)