Provider Demographics
NPI:1831745405
Name:HENDERSON, JUDERIUS (LCAS, LCSW-A)
Entity type:Individual
Prefix:
First Name:JUDERIUS
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LCAS, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 S MIAMI BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8288
Mailing Address - Country:US
Mailing Address - Phone:910-987-0292
Mailing Address - Fax:
Practice Address - Street 1:305 DOGTROT CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-8932
Practice Address - Country:US
Practice Address - Phone:910-987-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25696101YA0400X
NCP0138181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical