Individual
MR. WILLIE ALTON HENRY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
180 CENTRE ST, BROCKTON, MA 02302-2733
(617) 479-0102
(617) 479-0427
Mailing address
180 CENTRE ST, BROCKTON, MA 02302-2733
(617) 479-0102
(617) 479-0427
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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