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General NPI Number Information
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NPI Number | 1063748283
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Entity Type | Organization
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Legal Business Name | DANA HENDERSON, PH.D., P.C.
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 2952 VININGS FOREST WAY SE
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City | ATLANTA
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State | GA
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Zip | 30339-4222
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Country | US
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Telephone | 404-247-9274
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Fax | 770-434-8830
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Provider Business Mailing Address
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Address Line | 2952 VININGS FOREST WAY SE
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City | ATLANTA
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State | GA
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Zip | 30339-4222
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Country | US
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Telephone | 404-247-9274
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Fax | 770-434-8830
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANA HUGHES HENDERSON
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Credential | PH.D.
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Telephone | 404-247-9274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | PSY001261
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License Number State | GA
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