Provider Demographics
NPI:1932865094
Name:ROBINSON-HENDRICKS, VERCHELLE A (PHD, LPN, PS)
Entity Type:Individual
Prefix:MRS
First Name:VERCHELLE
Middle Name:A
Last Name:ROBINSON-HENDRICKS
Suffix:
Gender:F
Credentials:PHD, LPN, PS
Other - Prefix:DR
Other - First Name:VERCHELLE
Other - Middle Name:A
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 NEWSTEAD WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8772
Mailing Address - Country:US
Mailing Address - Phone:314-330-6480
Mailing Address - Fax:
Practice Address - Street 1:300 BERKSHIRE DR STE F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1859
Practice Address - Country:US
Practice Address - Phone:314-330-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC175T00000X, 374J00000X
TN743136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoula