Provider Demographics
NPI:1265693808
Name:DIANE HENDERSON ENTERPRISES INC
Entity type:Organization
Organization Name:DIANE HENDERSON ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:VALENTI
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:252-903-9926
Mailing Address - Street 1:112 N CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2430
Mailing Address - Country:US
Mailing Address - Phone:252-903-9926
Mailing Address - Fax:252-977-6114
Practice Address - Street 1:112 N CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:27804-2430
Practice Address - Country:US
Practice Address - Phone:252-903-9926
Practice Address - Fax:252-977-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0017331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty