Provider Demographics
NPI:1275252512
Name:HENDERSON, DANIELLE BAXTER (MS, LCMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:BAXTER
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 PRIYA ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-8623
Mailing Address - Country:US
Mailing Address - Phone:336-455-1416
Mailing Address - Fax:
Practice Address - Street 1:624 S FAYETTEVILLE ST STE A
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6582
Practice Address - Country:US
Practice Address - Phone:336-626-5040
Practice Address - Fax:336-629-0523
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health