Healthcare Provider Details

I. General information

NPI: 1609978014
Provider Name (Legal Business Name): TANIA HENDRICKS MA, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 CINCINNATI-BATAVIA PIKE
CINCINNATI OH
45244
US

IV. Provider business mailing address

4629 AICHOLTZ RD STE 2
CINCINNATI OH
45244-1560
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-752-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE 0500081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: