Healthcare Provider Details

I. General information

NPI: 1275944746
Provider Name (Legal Business Name): CHELSEY HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2014
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 MINNESOTA AVE NE
WASHINGTON DC
20019
US

IV. Provider business mailing address

3924 MINNESOTA AVE NE
WASHINGTON DC
20019-2661
US

V. Phone/Fax

Practice location:
  • Phone: 202-398-8684
  • Fax: 202-627-7815
Mailing address:
  • Phone: 202-398-8683
  • Fax: 202-627-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081674
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: