Provider Demographics
NPI:1154674273
Name:HENDERSON, DORINDA (LBSW)
Entity Type:Individual
Prefix:
First Name:DORINDA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 VAN HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-2743
Mailing Address - Country:US
Mailing Address - Phone:903-526-0505
Mailing Address - Fax:903-747-3830
Practice Address - Street 1:2726 VAN HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-2743
Practice Address - Country:US
Practice Address - Phone:903-526-0505
Practice Address - Fax:903-747-3830
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06598171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator