Healthcare Provider Details

I. General information

NPI: 1932865094
Provider Name (Legal Business Name): VERCHELLE A ROBINSON-HENDRICKS PHD, LPN, PS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. VERCHELLE A HENDRICKS

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BERKSHIRE DR STE F
COLUMBIA SC
29223-1859
US

IV. Provider business mailing address

101 NEWSTEAD WAY
COLUMBIA SC
29229-8772
US

V. Phone/Fax

Practice location:
  • Phone: 314-330-6480
  • Fax:
Mailing address:
  • Phone: 314-330-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number743136
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: