Provider Demographics
NPI:1013342930
Name:HENDERSON, SOPHIA JUSTINE (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:JUSTINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:JUSTINE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7400 MALONE ROAD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-1066
Mailing Address - Country:US
Mailing Address - Phone:707-529-8102
Mailing Address - Fax:
Practice Address - Street 1:7400 MALONE RD
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:CA
Practice Address - Zip Code:95436-9597
Practice Address - Country:US
Practice Address - Phone:707-529-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife