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General NPI Number Information
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NPI Number | 1497938211
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Entity Type | Individual
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Provider Name | DARRYL HENDERSON L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 5710 SIMMONS ST STE 102
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City | N LAS VEGAS
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State | NV
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Zip | 89031-7281
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Country | US
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Telephone | 702-823-3085
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Fax | 702-823-3017
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Provider Business Mailing Address
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Address Line | 5728 EMERALD VIEW ST
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City | LAS VEGAS
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State | NV
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Zip | 89130-1562
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Country | US
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Telephone | 702-823-3085
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Fax | 702-823-3017
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4556-C
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License Number State | NV
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