Provider Demographics
NPI:1740538537
Name:HENDERSON, RANDY E (LPC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:E
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 W ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1649
Mailing Address - Country:US
Mailing Address - Phone:304-813-4488
Mailing Address - Fax:304-822-3017
Practice Address - Street 1:52 W ROSEMARY LN
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1649
Practice Address - Country:US
Practice Address - Phone:304-813-4488
Practice Address - Fax:304-822-3017
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool