Provider Demographics
NPI:1386404416
Name:HENRY, EMILIA GUADALUPE (LGPC)
Entity type:Individual
Prefix:
First Name:EMILIA
Middle Name:GUADALUPE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 MIDSUMMER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3086
Mailing Address - Country:US
Mailing Address - Phone:240-646-4479
Mailing Address - Fax:
Practice Address - Street 1:8609 2ND AVE STE 404B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3374
Practice Address - Country:US
Practice Address - Phone:240-646-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health