Provider Demographics
NPI:1386309631
Name:HENRY, TAMICA MONIQUE
Entity type:Individual
Prefix:
First Name:TAMICA
Middle Name:MONIQUE
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 1:6755 BUSINESS PKWY STE 304
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6740
Mailing Address - Country:US
Mailing Address - Phone:404-201-4464
Mailing Address - Fax:
Practice Address - Street 1:6755 BUSINESS PKWY STE 304
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6740
Practice Address - Country:US
Practice Address - Phone:404-201-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health