Individual
EDWIN DEWAYNE HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1133 13TH ST, COLUMBUS, GA 31901-2248
(706) 225-0101
Mailing address
1133 13TH ST, COLUMBUS, GA 31901-2248
(706) 225-0101
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT1982925
BEHAVIORAL THERAPY
GA
Enumeration date
04/03/2019
Last updated
04/03/2019
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