Provider Demographics
NPI:1356887004
Name:HENDERSON, KAREN (CDP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0220
Mailing Address - Country:US
Mailing Address - Phone:509-533-6910
Mailing Address - Fax:509-535-2863
Practice Address - Street 1:5600 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0220
Practice Address - Country:US
Practice Address - Phone:509-533-6910
Practice Address - Fax:509-535-2863
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60474392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)