Provider Demographics
NPI:1033414974
Name:HENDERSON, CANDICE BLACKBURN (LPCC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:BLACKBURN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:MICHELLE
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:274 SOUTHLAND DR STE 204
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1946
Mailing Address - Country:US
Mailing Address - Phone:859-278-3456
Mailing Address - Fax:
Practice Address - Street 1:274 SOUTHLAND DR STE 204
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1946
Practice Address - Country:US
Practice Address - Phone:859-278-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1256101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor