Provider Demographics
NPI:1588355846
Name:HENSON, DAVID DWIGHT
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DWIGHT
Last Name:HENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:DWIGHT
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5801 HOLLISTER ST APT 715
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5728
Mailing Address - Country:US
Mailing Address - Phone:281-704-0625
Mailing Address - Fax:
Practice Address - Street 1:7171 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2563
Practice Address - Country:US
Practice Address - Phone:346-377-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26126121171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator