Provider Demographics
NPI:1700059078
Name:HENARD, EMALINE DAVIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:EMALINE
Middle Name:DAVIS
Last Name:HENARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:EMALINE
Other - Middle Name:HENARD
Other - Last Name:SKOLNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-
Mailing Address - Street 1:1360 N. PEGRAM STREET
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1932
Mailing Address - Country:US
Mailing Address - Phone:703-751-1985
Mailing Address - Fax:
Practice Address - Street 1:1360 N. PEGRAM STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1932
Practice Address - Country:US
Practice Address - Phone:703-751-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040001071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA033498Medicare UPIN