Provider Demographics
NPI:1922145432
Name:HENDERSON, LISA DANIELLE (BS, MS, MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DANIELLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BS, MS, MA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DANIELLE
Other - Last Name:BARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:331 54TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3317
Mailing Address - Country:US
Mailing Address - Phone:615-293-7462
Mailing Address - Fax:
Practice Address - Street 1:331 54TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3317
Practice Address - Country:US
Practice Address - Phone:615-293-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health