Provider Demographics
NPI:1114217031
Name:HENDERSON, PHEBEE VUN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PHEBEE
Middle Name:VUN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 HAZELBRAND RD NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-1510
Mailing Address - Country:US
Mailing Address - Phone:770-787-3977
Mailing Address - Fax:770-784-3022
Practice Address - Street 1:8201 HAZELBRAND RD NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1510
Practice Address - Country:US
Practice Address - Phone:770-787-3977
Practice Address - Fax:770-784-3022
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW 22901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical