Provider Demographics
NPI:1659990323
Name:HENDRICKSON, JADA
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LAC
Mailing Address - Street 1:212 E MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1004
Mailing Address - Country:US
Mailing Address - Phone:303-483-3930
Mailing Address - Fax:
Practice Address - Street 1:212 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1004
Practice Address - Country:US
Practice Address - Phone:303-483-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0109918101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)