Provider Demographics
NPI:1386011518
Name:HENDERSON, PATRICK (LPC,CRC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LPC,CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 NORTH DRUID HILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-556-2929
Mailing Address - Fax:
Practice Address - Street 1:3547 HABERSHAM AT NORTHLAKE
Practice Address - Street 2:BUILDING F
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:404-556-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional