Provider Demographics
NPI:1497938211
Name:HENDERSON, DARRYL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 EMERALD VIEW ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1562
Mailing Address - Country:US
Mailing Address - Phone:702-823-3085
Mailing Address - Fax:702-823-3017
Practice Address - Street 1:5710 SIMMONS ST STE 102
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-7281
Practice Address - Country:US
Practice Address - Phone:702-823-3085
Practice Address - Fax:702-823-3017
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4556-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical