Provider Demographics
NPI:1346831344
Name:HENDERSON, MAREON VINCENT (LICSW)
Entity Type:Individual
Prefix:
First Name:MAREON
Middle Name:VINCENT
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2528
Mailing Address - Country:US
Mailing Address - Phone:253-241-6871
Mailing Address - Fax:
Practice Address - Street 1:310 3RD AVE NE STE 109
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3346
Practice Address - Country:US
Practice Address - Phone:425-659-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607651361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical