Provider Demographics
NPI:1740659085
Name:HENDERSON, MASHAY MARIE I
Entity type:Individual
Prefix:MS
First Name:MASHAY
Middle Name:MARIE
Last Name:HENDERSON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 6TH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:95823
Mailing Address - Country:UM
Mailing Address - Phone:916-482-2370
Mailing Address - Fax:916-349-7537
Practice Address - Street 1:3555 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-482-2370
Practice Address - Fax:916-349-7537
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health