Provider Demographics
NPI:1871663294
Name:HENDERSON, KATHERINE R (LMHC, LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMHC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 STATE ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:HOGANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13655
Mailing Address - Country:US
Mailing Address - Phone:518-358-3141
Mailing Address - Fax:518-358-9175
Practice Address - Street 1:404 STATE ROUTE 37
Practice Address - Street 2:
Practice Address - City:HOGANSBURG
Practice Address - State:NY
Practice Address - Zip Code:13655
Practice Address - Country:US
Practice Address - Phone:518-358-3141
Practice Address - Fax:518-358-9175
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003345-1101YM0800X
NY0870711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC008373OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD
NY003345OtherLICENSED MENTAL HEALTH COUNSELOR