Provider Demographics
NPI:1548412208
Name:HENDERSON, VIVIEN MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:VIVIEN
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:VIVACIOUS
Other - Middle Name:
Other - Last Name:HEALING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2960 BURGOYNE LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7240
Mailing Address - Country:US
Mailing Address - Phone:561-317-2038
Mailing Address - Fax:
Practice Address - Street 1:2960 BURGOYNE LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-7240
Practice Address - Country:US
Practice Address - Phone:561-317-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52819174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist