Provider Demographics
NPI:1982266326
Name:HENDERSON, LACAGE MARIE
Entity Type:Individual
Prefix:
First Name:LACAGE
Middle Name:MARIE
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 1:3860 S TRADEWINDS CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-9410
Mailing Address - Country:US
Mailing Address - Phone:810-986-7053
Mailing Address - Fax:
Practice Address - Street 1:2521 E MOUNTAIN VILLAGE DR STE F
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7373
Practice Address - Country:US
Practice Address - Phone:907-290-3760
Practice Address - Fax:907-631-0647
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)