Provider Demographics
NPI:1558151506
Name:HENDERSON, VANESSA (LCDC-I)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 GATTIS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2821
Mailing Address - Country:US
Mailing Address - Phone:512-368-2809
Mailing Address - Fax:
Practice Address - Street 1:2631 GATTIS SCHOOL RD STE 455
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2969
Practice Address - Country:US
Practice Address - Phone:512-368-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)