Provider Demographics
NPI:1497224927
Name:HENDERSON, REBECCA LEAH (LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEAH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:WATSON
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10710 MIDLOTHIAN TPKE STE 127
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4776
Mailing Address - Country:US
Mailing Address - Phone:804-280-0832
Mailing Address - Fax:
Practice Address - Street 1:10710 MIDLOTHIAN TPKE STE 127
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4776
Practice Address - Country:US
Practice Address - Phone:804-280-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3630106H00000X
GAMFT001263106H00000X
VA0717001752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist