Healthcare Provider Details

I. General information

NPI: 1689708638
Provider Name (Legal Business Name): CYNTHIA LOCKE HENDERSON LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-3865
US

IV. Provider business mailing address

526 E INDIAN SPRING DR
SILVER SPRING MD
20901-4727
US

V. Phone/Fax

Practice location:
  • Phone: 202-581-2455
  • Fax:
Mailing address:
  • Phone: 301-587-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302082
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08086
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: