Provider Demographics
NPI:1649749292
Name:HENDERSON, DAMARIA
Entity Type:Individual
Prefix:
First Name:DAMARIA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 W TUNNEL BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2811
Mailing Address - Country:US
Mailing Address - Phone:504-314-1737
Mailing Address - Fax:985-231-1377
Practice Address - Street 1:1340 W TUNNEL BLVD STE 230
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2811
Practice Address - Country:US
Practice Address - Phone:504-314-1737
Practice Address - Fax:985-231-1377
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health