MEDICARE: MRS. KITTY CAUGHMAN HENDERSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2226	SC

General Provider Information

NPI Number	:	1255640017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KITTY CAUGHMAN HENDERSON LPC

Provider Business Mailing Address
First Line	:	1615 PICKENS ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3450
Country	:	US
Telephone Number	:	803-252-3001
Fax Number	:	803-252-0211

Provider Business Practice Location Address
First Line	:	1615 PICKENS ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3450
Country	:	US
Telephone Number	:	803-252-3001
Fax Number	:	803-252-0211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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