Healthcare Provider Details

I. General information

NPI: 1184815045
Provider Name (Legal Business Name): ANNETTE MARIE HENDERSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CENTER ST SUITE 4
LANSING MI
48906-5258
US

IV. Provider business mailing address

809 CENTER ST SUITE 4
LANSING MI
48906-5258
US

V. Phone/Fax

Practice location:
  • Phone: 517-367-2489
  • Fax:
Mailing address:
  • Phone: 517-367-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801079498
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: