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General NPI Number Information
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NPI Number | 1932327038
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Entity Type | Individual
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Provider Name | GENEVA ANTIONETTE HENDERSON LPC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 2510 CAPROCK CT
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City | CHARLOTTE
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State | NC
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Zip | 28213
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Country | US
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Telephone | 803-378-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 CAPROCK CT
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City | CHARLOTTE
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State | NC
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Zip | 28213-5260
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Country | US
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Telephone | 252-503-3572
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4958
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9706
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License Number State | NC
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