Provider Demographics
NPI:1982831418
Name:HENDERSON-SMITH, LINDA YVONNE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:YVONNE
Last Name:HENDERSON-SMITH
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 DOE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6201
Mailing Address - Country:US
Mailing Address - Phone:323-240-6543
Mailing Address - Fax:
Practice Address - Street 1:1345 DOE VALLEY DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6201
Practice Address - Country:US
Practice Address - Phone:323-240-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA569644507AMedicaid