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General NPI Number Information
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NPI Number | 1104342096
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Entity Type | Individual
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Provider Name | KAYLENE SCHOLL HENDERSON MA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 52 SUNFLOWER CT
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City | ELLIJAY
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State | GA
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Zip | 30540-3054
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Country | US
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Telephone | 706-455-9028
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Fax | 706-455-9028
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Provider Business Mailing Address
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Address Line | 52 SUNFLOWER CT
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City | ELLIJAY
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State | GA
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Zip | 30540-5120
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Country | US
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Telephone | 706-455-9028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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