Provider Demographics
NPI:1538315338
Name:HENDERSON, THOMAS J (MS, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2443
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2443
Mailing Address - Country:US
Mailing Address - Phone:252-331-1494
Mailing Address - Fax:252-331-0308
Practice Address - Street 1:330 CAMDEN CSWY
Practice Address - Street 2:SUITE A
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6811
Practice Address - Country:US
Practice Address - Phone:252-331-1494
Practice Address - Fax:252-331-0308
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA841231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist