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General NPI Number Information
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NPI Number | 1225547508
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Entity Type | Individual
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Provider Name | MARY KATHLEEN HENDERSON LADC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 393 MAIN ST
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City | DANVILLE
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State | NH
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Zip | 03819-3219
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Country | US
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Telephone | 603-560-2854
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 431
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City | EAST HAMPSTEAD
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State | NH
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Zip | 03826-0431
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Country | US
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Telephone | 503-560-2854
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | NH0125
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License Number State | NH
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