Healthcare Provider Details

I. General information

NPI: 1912801465
Provider Name (Legal Business Name): RODNEY LORENZO HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

911 DEERBERRY CT
ODENTON MD
21113-2755
US

V. Phone/Fax

Practice location:
  • Phone: 800-507-5550
  • Fax:
Mailing address:
  • Phone: 202-302-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: