Provider Demographics
NPI:1295358638
Name:MISTY COX HENDERSON, LCSW, LLC
Entity Type:Organization
Organization Name:MISTY COX HENDERSON, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, LLC
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-230-8589
Mailing Address - Street 1:1010 CUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-2718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 RADFORD ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3303
Practice Address - Country:US
Practice Address - Phone:540-230-8589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty