Provider Demographics
NPI:1366251738
Name:HENSON, RONALD WAYNE (LPC, MA CMHC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WAYNE
Last Name:HENSON
Suffix:
Gender:M
Credentials:LPC, MA CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 VANDALIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4068
Mailing Address - Country:US
Mailing Address - Phone:847-854-4333
Mailing Address - Fax:847-854-4333
Practice Address - Street 1:850 VANDALIA ST STE 200
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4068
Practice Address - Country:US
Practice Address - Phone:847-854-4333
Practice Address - Fax:847-854-4333
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health