Provider Demographics
NPI:1265470074
Name:HENDERSON, MARCELLA BURSI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:BURSI
Last Name:HENDERSON
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 1:230 DUNCAN DR BLDG 1440
Mailing Address - Street 2:RANGER HALL
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31409-5107
Mailing Address - Country:US
Mailing Address - Phone:912-224-9766
Mailing Address - Fax:
Practice Address - Street 1:230 DUNCAN DR BLDG 1440
Practice Address - Street 2:RANGER HALL
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5107
Practice Address - Country:US
Practice Address - Phone:912-224-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical