Healthcare Provider Details

I. General information

NPI: 1902402712
Provider Name (Legal Business Name): NICOLE ALEXANDRA HENDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 S BROADWAY STE 300
LITTLETON CO
80122-2633
US

IV. Provider business mailing address

10224 W GEDDES CIR
LITTLETON CO
80127-3452
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax:
Mailing address:
  • Phone: 408-656-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09927402
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: