Provider Demographics
NPI:1891247672
Name:HENDERSON, KENISHA (LCSW)
Entity Type:Individual
Prefix:
First Name:KENISHA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MCKINNEY PLACE DR APT 109
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2170
Mailing Address - Country:US
Mailing Address - Phone:773-414-3586
Mailing Address - Fax:
Practice Address - Street 1:5500 MCKINNEY PLACE DR APT 109
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2170
Practice Address - Country:US
Practice Address - Phone:773-414-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677121041C0700X
IL227016133225700000X
TXMT131288225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical