Provider Demographics
NPI:1891075081
Name:HENDERSON, DENESE WALTERS (MFT)
Entity Type:Individual
Prefix:MRS
First Name:DENESE
Middle Name:WALTERS
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DENESE
Other - Middle Name:
Other - Last Name:WALERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3312 N OAK STREET EXT BLDG D
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1066
Mailing Address - Country:US
Mailing Address - Phone:229-244-2030
Mailing Address - Fax:229-244-2038
Practice Address - Street 1:3312 N OAK STREET EXT BLDG D
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1066
Practice Address - Country:US
Practice Address - Phone:229-244-2030
Practice Address - Fax:229-244-2038
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001208106H00000X
GA000196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist