Healthcare Provider Details

I. General information

NPI: 1831654342
Provider Name (Legal Business Name): JADA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 13TH ST
COLUMBUS GA
31901-2246
US

IV. Provider business mailing address

2022 15TH AVE
COLUMBUS GA
31901-1699
US

V. Phone/Fax

Practice location:
  • Phone: 706-780-1704
  • Fax:
Mailing address:
  • Phone: 706-649-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002337
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL325
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: