Provider Demographics
NPI:1821374463
Name:HENDERSON, DONALD KIRK (MA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:KIRK
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:KIRK
Other - Middle Name:D
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:100 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:615-854-5693
Mailing Address - Fax:
Practice Address - Street 1:7003 CHADWICK DR STE 133
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5288
Practice Address - Country:US
Practice Address - Phone:615-854-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61516078101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH61516078OtherCLINICAL LICENSE