Provider Demographics
NPI:1083947501
Name:HENDERSON, ROCHELLE ANN
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:ANN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:ANN
Other - Last Name:THROWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1693 EASTMAN LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1623
Mailing Address - Country:US
Mailing Address - Phone:707-799-4627
Mailing Address - Fax:
Practice Address - Street 1:3641 STONY POINT RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-8080
Practice Address - Country:US
Practice Address - Phone:707-585-3700
Practice Address - Fax:707-585-3883
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health