Provider Demographics
NPI:1174389324
Name:HENRY, UNIQUE MICHELLE
Entity type:Individual
Prefix:
First Name:UNIQUE
Middle Name:MICHELLE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:UNIQUE
Other - Middle Name:MICHELLE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5510 SW LOOP 410 UNIT 27476
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-0827
Mailing Address - Country:US
Mailing Address - Phone:615-504-4212
Mailing Address - Fax:
Practice Address - Street 1:7428 W MILITARY DR STE D27476
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-3010
Practice Address - Country:US
Practice Address - Phone:615-504-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)