Provider Demographics
NPI:1982714929
Name:HENRICKS, GLORIA LYNNE (MA)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LYNNE
Last Name:HENRICKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:LYNNE
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 NW CLUSTER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1064
Mailing Address - Country:US
Mailing Address - Phone:541-926-2910
Mailing Address - Fax:
Practice Address - Street 1:2400 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1221
Practice Address - Country:US
Practice Address - Phone:503-361-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0447101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor