MEDICARE: ALEC CRAIG HENDERSON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1265372486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEC CRAIG HENDERSON

Provider Business Mailing Address
First Line	:	1900 ELECTRIC RD
Second Line	:	CHLOE ELLIOTT 540-204-3274
City	:	SALEM
State	:	VA
Zip	:	24153-7474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	LEWISGALE BEHAVIORAL HEALTH PAVILION 1902 BRAEBURN DR.
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153
Country	:	US
Telephone Number	:	540-776-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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