Provider Demographics
NPI:1942883087
Name:HENRY, TAMIA M (LCMHCA)
Entity type:Individual
Prefix:
First Name:TAMIA
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 GRAND MANOR CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5525
Mailing Address - Country:US
Mailing Address - Phone:980-616-9406
Mailing Address - Fax:
Practice Address - Street 1:4805 GREEN RD STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2848
Practice Address - Country:US
Practice Address - Phone:919-872-6220
Practice Address - Fax:919-872-6223
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health