Healthcare Provider Details

I. General information

NPI: 1891138541
Provider Name (Legal Business Name): HOLLY NORMA HENDERSON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S CREYTS RD, STE F
LANSING MI
48917-8268
US

IV. Provider business mailing address

516 S CREYTS RD STE F
LANSING MI
48917-8268
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-1767
  • Fax: 517-580-7180
Mailing address:
  • Phone: 517-323-1767
  • Fax: 517-580-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094776
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: