Provider Demographics
NPI:1851805444
Name:HENDERSON, MARCEL DENICE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:DENICE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1606
Mailing Address - Country:US
Mailing Address - Phone:770-634-3315
Mailing Address - Fax:
Practice Address - Street 1:83 BARNES ST
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-2036
Practice Address - Country:US
Practice Address - Phone:770-634-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional