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General NPI Number Information
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NPI Number | 1831745611
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Entity Type | Individual
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Provider Name | TINA LUCILLE HENDERSON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 169 SUFFOLK AVE STE 1
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City | RICHLANDS
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State | VA
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Zip | 24641-2434
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Country | US
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Telephone | 276-821-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 1981 SCRATCH GRAVEL RD
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City | MARION
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State | VA
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Zip | 24354-7015
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Country | US
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Telephone | 276-780-4946
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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 | 364SP0813X
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Taxonomy Name | Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 0024178041
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License Number State | VA
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