Provider Demographics
NPI:1821570300
Name:HENDERSON-CLARK, ROCHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:
Last Name:HENDERSON-CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 PRESTIGE CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9437
Mailing Address - Country:US
Mailing Address - Phone:757-329-0862
Mailing Address - Fax:
Practice Address - Street 1:800 SEAHAWK CIR STE 110
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7818
Practice Address - Country:US
Practice Address - Phone:757-301-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional