Provider Demographics
NPI:1689358699
Name:HENDERSON, LAURDES BLANCA (MS, LCMHCA)
Entity Type:Individual
Prefix:
First Name:LAURDES
Middle Name:BLANCA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, LCMHCA
Other - Prefix:
Other - First Name:LAURDES
Other - Middle Name:BLANCA
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:10650 TIGERTON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1447
Mailing Address - Country:US
Mailing Address - Phone:704-490-5504
Mailing Address - Fax:
Practice Address - Street 1:1909 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4509
Practice Address - Country:US
Practice Address - Phone:980-313-3020
Practice Address - Fax:704-980-8023
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health