Provider Demographics
NPI:1164766739
Name:HENNINGER, LINDSEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 HEADQUARTERS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7484
Mailing Address - Country:US
Mailing Address - Phone:843-740-1624
Mailing Address - Fax:843-740-6166
Practice Address - Street 1:4360 HEADQUARTERS RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7484
Practice Address - Country:US
Practice Address - Phone:843-740-1624
Practice Address - Fax:843-740-6166
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical