Provider Demographics
NPI:1841624327
Name:LAURA S HENDERSON LMSW PLLC
Entity type:Organization
Organization Name:LAURA S HENDERSON LMSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-799-4350
Mailing Address - Street 1:147 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2141
Mailing Address - Country:US
Mailing Address - Phone:586-219-0504
Mailing Address - Fax:810-794-7751
Practice Address - Street 1:43200 DEQUINDRE RD
Practice Address - Street 2:STE 104
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1707
Practice Address - Country:US
Practice Address - Phone:586-799-4350
Practice Address - Fax:586-799-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010684251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty