Provider Demographics
NPI:1073304564
Name:HENDRICKSON, ELIZABETH (LMAC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 40TH ST SW UNIT B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1184
Mailing Address - Country:US
Mailing Address - Phone:701-478-8440
Mailing Address - Fax:651-925-0046
Practice Address - Street 1:505 40TH ST SW UNIT B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1184
Practice Address - Country:US
Practice Address - Phone:701-478-8440
Practice Address - Fax:651-925-0046
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1777101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)