Provider Demographics
NPI:1457772840
Name:HENRY, REBECCA (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HOPELESS RD
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-5533
Mailing Address - Country:US
Mailing Address - Phone:865-296-0823
Mailing Address - Fax:
Practice Address - Street 1:1604 HOPELESS RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-5533
Practice Address - Country:US
Practice Address - Phone:865-296-0823
Practice Address - Fax:865-770-5232
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000076861041C0700X
TN00000059611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical