Healthcare Provider Details

I. General information

NPI: 1497224927
Provider Name (Legal Business Name): REBECCA LEAH HENDERSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA WATSON FRAZIER

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 DUNKIRK DR
CHESTER VA
23831-6814
US

IV. Provider business mailing address

4615 DUNKIRK DR
CHESTER VA
23831-6814
US

V. Phone/Fax

Practice location:
  • Phone: 478-972-0747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10290
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001263
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3630
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001752
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: