Provider Demographics
NPI:1508429358
Name:HENDERSON, CASARAH (MS)
Entity Type:Individual
Prefix:
First Name:CASARAH
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POLK ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1637
Mailing Address - Country:US
Mailing Address - Phone:321-999-6382
Mailing Address - Fax:
Practice Address - Street 1:1060 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4919
Practice Address - Country:US
Practice Address - Phone:407-307-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor