Healthcare Provider Details

I. General information

NPI: 1376363242
Provider Name (Legal Business Name): AISHA H HENDERSON M.A., PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 MANHATTAN BLVD STE 207
HARVEY LA
70058-5361
US

IV. Provider business mailing address

PO BOX 154
MARRERO LA
70073-0154
US

V. Phone/Fax

Practice location:
  • Phone: 504-364-8949
  • Fax: 504-364-8968
Mailing address:
  • Phone: 504-250-5639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10420
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: