Healthcare Provider Details

I. General information

NPI: 1689207052
Provider Name (Legal Business Name): ALICIA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 WOODMONT DR
PARRISH FL
34219-1658
US

IV. Provider business mailing address

3322 WOODMONT DR
PARRISH FL
34219-1658
US

V. Phone/Fax

Practice location:
  • Phone: 865-805-1766
  • Fax:
Mailing address:
  • Phone: 865-805-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4749
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: