Healthcare Provider Details

I. General information

NPI: 1730981499
Provider Name (Legal Business Name): ERICA HENDERSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 CHANDLER CT
ALTO GA
30510-3012
US

IV. Provider business mailing address

360 CHANDLER CT
ALTO GA
30510-3012
US

V. Phone/Fax

Practice location:
  • Phone: 678-936-0059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW010913
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: