MEDICARE: YAMINA A 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	101YM0800X	Mental Health Counselor	C1000080	OH

General Provider Information

NPI Number	:	1689998254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMINA A HENDERSON LPC

Provider Business Mailing Address
First Line	:	2085 MECCA RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4512
Country	:	US
Telephone Number	:	937-504-2170
Fax Number	:

Provider Business Practice Location Address
First Line	:	2085 MECCA RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4512
Country	:	US
Telephone Number	:	937-504-2170
Fax Number	:

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

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	09/18/2018

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