Provider Demographics
NPI:1184815045
Name:HENDERSON, ANNETTE MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:MARIE
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 1:809 CENTER ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5258
Mailing Address - Country:US
Mailing Address - Phone:517-367-2489
Mailing Address - Fax:
Practice Address - Street 1:809 CENTER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5258
Practice Address - Country:US
Practice Address - Phone:517-367-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010794981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008980640OtherBCBS-TRADITIONAL