Provider Demographics
NPI:1326337866
Name:HENDERSON, EUNICE (MSED)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9410
Mailing Address - Country:US
Mailing Address - Phone:724-444-6536
Mailing Address - Fax:
Practice Address - Street 1:5425 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9410
Practice Address - Country:US
Practice Address - Phone:724-444-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional