Provider Demographics
NPI:1376183376
Name:HENDERSON, NICOLE MARIE (LPC, BSL)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 APPLEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7402
Mailing Address - Country:US
Mailing Address - Phone:412-335-0895
Mailing Address - Fax:
Practice Address - Street 1:640 APPLEVIEW LN
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-7402
Practice Address - Country:US
Practice Address - Phone:412-335-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional