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General NPI Number Information
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NPI Number | 1841624327
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Entity Type | Organization
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Legal Business Name | LAURA S HENDERSON LMSW PLLC
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 43200 DEQUINDRE RD STE 104
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City | STERLING HTS
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State | MI
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Zip | 48314-1707
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Country | US
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Telephone | 586-799-4350
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Fax | 586-799-4279
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Provider Business Mailing Address
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Address Line | 147 S HIGHLAND ST
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2141
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Country | US
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Telephone | 586-219-0504
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Fax | 810-794-7751
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Authorized Official
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Title or Position | OWNER
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Name | LAURA S HENDERSON
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Credential | LMSW
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Telephone | 586-799-4350
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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 | 6801068425
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License Number State | MI
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