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General NPI Number Information
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NPI Number | 1265096119
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Entity Type | Individual
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Provider Name | DIAMOND HENDERSON LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 3816 N ELM ST STE C
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City | GREENSBORO
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State | NC
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Zip | 27455-2776
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Country | US
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Telephone | 336-545-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 440 MAGNOLIA BRANCH DR APT 10
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City | WINSTON SALEM
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State | NC
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Zip | 27104-4409
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Country | US
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Telephone | 404-513-2306
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A14776
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License Number State | NC
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