Healthcare Provider Details

I. General information

NPI: 1891028783
Provider Name (Legal Business Name): CAMILLA C. HENDREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMILLE C. HENDREN LCSW

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10432 BALLS FORD RD STE 300
MANASSAS VA
20109-2517
US

IV. Provider business mailing address

10432 BALLS FORD RD STE 300
MANASSAS VA
20109-2517
US

V. Phone/Fax

Practice location:
  • Phone: 816-769-4486
  • Fax: 816-817-3985
Mailing address:
  • Phone: 816-769-4486
  • Fax: 816-817-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2009016896
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081437
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: