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General NPI Number Information
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NPI Number | 1821076985
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Entity Type | Individual
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Provider Name | CAROLYN R. HENDERSON MFT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2006
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 641 HIGUERA ST SUITE 202
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3549
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Country | US
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Telephone | 805-596-0234
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Fax | 805-929-2717
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Provider Business Mailing Address
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Address Line | 250 N LAS FLORES DR
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City | NIPOMO
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State | CA
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Zip | 93444-9246
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Country | US
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Telephone | 805-704-4640
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Fax | 805-929-2717
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC37330
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License Number State | CA
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