Provider Demographics
NPI:1003646779
Name:HENDERSHOT, THOMAS B (LPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:B
Last Name:HENDERSHOT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRITTIN AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1954
Mailing Address - Country:US
Mailing Address - Phone:856-882-2255
Mailing Address - Fax:
Practice Address - Street 1:601 NORTH 4TH STREET
Practice Address - Street 2:SAA
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9722
Practice Address - Country:US
Practice Address - Phone:609-567-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00799800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional