Healthcare Provider Details

I. General information

NPI: 1427384460
Provider Name (Legal Business Name): ROSE L HENDERSON LICDC,PC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 READING RD
CINCINNATI OH
45229-1215
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 513-641-4300
  • Fax: 513-482-1692
Mailing address:
  • Phone: 513-751-7747
  • Fax: 513-872-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0006015-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0006015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: