Provider Demographics
NPI:1942446307
Name:HENDERSON, SANDRA H (PHD, LCP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:H
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9376 ATLEE STATION RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2602
Mailing Address - Country:US
Mailing Address - Phone:804-730-0990
Mailing Address - Fax:
Practice Address - Street 1:9376 ATLEE STATION RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2602
Practice Address - Country:US
Practice Address - Phone:804-730-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004045103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent