Provider Demographics
NPI:1861862765
Name:HENRY, TONY SHERROD (BS PP)
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:SHERROD
Last Name:HENRY
Suffix:
Gender:M
Credentials:BS PP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3225
Mailing Address - Country:US
Mailing Address - Phone:706-756-2517
Mailing Address - Fax:706-756-2107
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:SUITE 228
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3225
Practice Address - Country:US
Practice Address - Phone:706-756-2517
Practice Address - Fax:706-756-2107
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health