Provider Demographics
NPI:1891138541
Name:HENDERSON, HOLLY NORMA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:NORMA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 S CREYTS RD
Mailing Address - Street 2:STE F
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8268
Mailing Address - Country:US
Mailing Address - Phone:517-323-1767
Mailing Address - Fax:517-580-7180
Practice Address - Street 1:516 S CREYTS RD, STE F
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8268
Practice Address - Country:US
Practice Address - Phone:517-323-1767
Practice Address - Fax:517-580-7180
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010947761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical