Provider Demographics
NPI:1558935999
Name:HENDERSON SOWERS, LISA (MS, MA/AGS, LGPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:HENDERSON SOWERS
Suffix:
Gender:F
Credentials:MS, MA/AGS, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 MAIN STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:410-505-0062
Mailing Address - Fax:
Practice Address - Street 1:8181 MAIN STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-505-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional