Healthcare Provider Details

I. General information

NPI: 1063388304
Provider Name (Legal Business Name): CELESTE HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9306 FRENSHAM CT
LAUREL MD
20708-2855
US

IV. Provider business mailing address

9306 FRENSHAM CT
LAUREL MD
20708-2855
US

V. Phone/Fax

Practice location:
  • Phone: 410-852-8382
  • Fax:
Mailing address:
  • Phone: 410-852-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: