Provider Demographics
NPI:1093049033
Name:HENDERSON SIMA, IDA MARIE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:IDA MARIE
Middle Name:
Last Name:HENDERSON SIMA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 JARRETTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1524
Mailing Address - Country:US
Mailing Address - Phone:443-613-6233
Mailing Address - Fax:
Practice Address - Street 1:1714 JARRETTSVILLE RD
Practice Address - Street 2:NORTH HARFORD COUNSELING, LLC
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1524
Practice Address - Country:US
Practice Address - Phone:443-613-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical