Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 6801093703 | MI |
NPI | 1003193996 |
---|---|
Provider Name | Adam Charles Mchenry |
First Address | Port Huron, MI 48060-5416 |
Second Address | Port Huron, MI 48060-5416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2011 |
Last Update Date | 07/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
382230613 | FIN (01) | MI |