Provider Demographics
NPI:1023460904
Name:HENDERSON, NANCY (LPC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24925 JEFFERSON AVE
Mailing Address - Street 2:APT 9
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2871
Mailing Address - Country:US
Mailing Address - Phone:313-721-6402
Mailing Address - Fax:
Practice Address - Street 1:19445 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3361
Practice Address - Country:US
Practice Address - Phone:313-307-0088
Practice Address - Fax:313-281-2235
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health