Provider Demographics
NPI:1669625497
Name:HENDERSON, LAWRENCE LEVI (LCSW)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:LEVI
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:ERNEST
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 330716
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-753-0743
Mailing Address - Fax:
Practice Address - Street 1:417 HARDING DR
Practice Address - Street 2:SUITE D
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4079
Practice Address - Country:US
Practice Address - Phone:615-753-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14901311671041C0700X
TN6132051041C0700X
TN11954131041C0700X
IL1490131671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical