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General NPI Number Information
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NPI Number | 1932374840
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Entity Type | Individual
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Provider Name | MS. LASHONDA HAROLYN HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 2059 SE HILLMOOR DR #304
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-8063
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Country | US
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Telephone | 772-333-6488
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Fax |
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Provider Business Mailing Address
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Address Line | 2059 SE HILLMOOR DR 304
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-8063
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Country | US
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Telephone | 772-333-6488
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ADC-010575-2015
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 13816
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License Number State | FL
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