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General NPI Number Information
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NPI Number | 1669625497
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Entity Type | Individual
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Provider Name | LAWRENCE LEVI HENDERSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 417 HARDING DR SUITE D
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City | LEBANON
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State | TN
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Zip | 37087-4079
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Country | US
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Telephone | 615-753-0743
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 330716
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City | NASHVILLE
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State | TN
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Zip | 37203
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Country | US
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Telephone | 615-753-0743
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1490131167
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 613205
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1195413
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149013167
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License Number State | IL
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