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General NPI Number Information
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NPI Number | 1629546213
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Entity Type | Individual
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Provider Name | JEFFERY B HENDERSON
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Gender | Male
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 950 HIGHWAY 431 STE 1
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City | ROANOKE
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State | AL
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Zip | 36274-7314
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Country | US
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Telephone | 706-885-4553
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Fax |
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Provider Business Mailing Address
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Address Line | 950 HIGHWAY 431 STE 1
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City | ROANOKE
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State | AL
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Zip | 36274-7314
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Country | US
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Telephone | 706-885-4553
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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