Provider Demographics
NPI:1942088661
Name:HENDERSON, EBONEIKA D (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EBONEIKA
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EBBIE
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4464 DEVINE ST
Mailing Address - Street 2:#1014 STE M
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205
Mailing Address - Country:US
Mailing Address - Phone:803-714-3935
Mailing Address - Fax:803-620-1044
Practice Address - Street 1:4464 DEVINE ST STE M
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3605
Practice Address - Country:US
Practice Address - Phone:803-714-3935
Practice Address - Fax:803-620-1044
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health