Healthcare Provider Details

I. General information

NPI: 1265372486
Provider Name (Legal Business Name): ALEC CRAIG HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEWISGALE BEHAVIORAL HEALTH PAVILION 1902 BRAEBURN DR.
SALEM VA
24153
US

IV. Provider business mailing address

1900 ELECTRIC RD CHLOE ELLIOTT 540-204-3274
SALEM VA
24153-7474
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: