Provider Demographics
NPI:1437307089
Name:HENDERSON, DONIA LEE (LPC,CMT)
Entity Type:Individual
Prefix:MS
First Name:DONIA
Middle Name:LEE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3078 W 134TH PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5205
Mailing Address - Country:US
Mailing Address - Phone:720-260-3961
Mailing Address - Fax:
Practice Address - Street 1:3078 W 134TH PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:720-260-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14307900225700000X
CO0012618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist