Provider Demographics
NPI:1932301017
Name:HENDERSON, LOVE KRISHAUN
Entity Type:Individual
Prefix:MISS
First Name:LOVE
Middle Name:KRISHAUN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MOUNTAIN ST NW
Mailing Address - Street 2:APT A-2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2334
Mailing Address - Country:US
Mailing Address - Phone:256-147-6160
Mailing Address - Fax:256-741-6180
Practice Address - Street 1:1200 NOBLE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4659
Practice Address - Country:US
Practice Address - Phone:256-741-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor