Provider Demographics
NPI:1376586818
Name:HENDERSON, JUDY L (LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 W 6TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2829
Mailing Address - Country:US
Mailing Address - Phone:252-758-4810
Mailing Address - Fax:252-758-3790
Practice Address - Street 1:1705 W 6TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2829
Practice Address - Country:US
Practice Address - Phone:252-758-4810
Practice Address - Fax:252-758-3790
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health