Healthcare Provider Details

I. General information

NPI: 1639985005
Provider Name (Legal Business Name): DR. RAMAR HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W FALLBROOK AVE STE 105
FRESNO CA
93711-6191
US

IV. Provider business mailing address

839 SUNSET BLVD
ARCADIA CA
91007-6557
US

V. Phone/Fax

Practice location:
  • Phone: 559-549-3673
  • Fax:
Mailing address:
  • Phone: 559-549-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number543553
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: