Provider Demographics
NPI:1851018816
Name:HENDERSON, NEKESHIA
Entity Type:Individual
Prefix:
First Name:NEKESHIA
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 1:2201 SEVERN AVE APT E206
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7621
Mailing Address - Country:US
Mailing Address - Phone:225-456-7656
Mailing Address - Fax:
Practice Address - Street 1:2201 SEVERN AVE APT E206
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7621
Practice Address - Country:US
Practice Address - Phone:225-456-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA009291689Medicaid