Provider Demographics
NPI:1437623642
Name:HENDERSON, CHASITY RENE
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:RENE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-3711
Mailing Address - Country:US
Mailing Address - Phone:662-728-2488
Mailing Address - Fax:662-728-9803
Practice Address - Street 1:609 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3711
Practice Address - Country:US
Practice Address - Phone:662-728-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor