Provider Demographics
NPI:1932374840
Name:HENDERSON, LASHONDA HAROLYN
Entity Type:Individual
Prefix:MS
First Name:LASHONDA
Middle Name:HAROLYN
Last Name:HENDERSON
Suffix:
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 1:2059 SE HILLMOOR DR
Mailing Address - Street 2:304
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8063
Mailing Address - Country:US
Mailing Address - Phone:772-333-6488
Mailing Address - Fax:
Practice Address - Street 1:2059 SE HILLMOOR DR
Practice Address - Street 2:#304
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8063
Practice Address - Country:US
Practice Address - Phone:772-333-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-010575-2015101YA0400X
101YM0800X
FLMH 13816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)