MEDICARE: JESSICA HENDERSON, LCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144152679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA HENDERSON, LCSW, LLC

Provider Business Mailing Address
First Line	:	10912 BLUEBELL DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-2137
Country	:	US
Telephone Number	:	804-874-9676
Fax Number	:

Provider Business Practice Location Address
First Line	:	10912 BLUEBELL DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-2137
Country	:	US
Telephone Number	:	804-874-9676
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUDITH JESSICA HENDERSON
Credential	:	LCSW
Telephone Number	:	804-874-9676

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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