Provider Demographics
NPI:1952039224
Name:HENDERSON, DANIELLE EVETTE (BS)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:EVETTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16464 VERONICA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3056
Mailing Address - Country:US
Mailing Address - Phone:313-657-0748
Mailing Address - Fax:
Practice Address - Street 1:16464 VERONICA AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3056
Practice Address - Country:US
Practice Address - Phone:313-657-0748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator