Healthcare Provider Details

I. General information

NPI: 1700636800
Provider Name (Legal Business Name): DARIUS KHADAR HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 CRENSHAW BLVD
LOS ANGELES CA
90008-1821
US

IV. Provider business mailing address

730 S VANCE ST
LAKEWOOD CO
80226-5028
US

V. Phone/Fax

Practice location:
  • Phone: 323-593-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0021448
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: