Individual
ETHAN DANIEL HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 WADE LN, LYNCHBURG, VA 24502-2935
(951) 414-7785
Mailing address
115 WADE LN, LYNCHBURG, VA 24502-2935
(951) 414-7785
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0021940
CO
Other
Enumeration date
03/11/2025
Last updated
03/11/2025
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