Provider Demographics
NPI:1174862528
Name:HENDRICKSON, COREENA D (LCSW)
Entity Type:Individual
Prefix:
First Name:COREENA
Middle Name:D
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N ST ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4020
Mailing Address - Country:US
Mailing Address - Phone:323-810-4465
Mailing Address - Fax:
Practice Address - Street 1:108 N ST ANDREWS PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4020
Practice Address - Country:US
Practice Address - Phone:323-810-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS157351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical