MEDICARE: DR. MICHAEL HENDERSON PH.D., LBA, BCBA-D

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	103K00000X	Behavior Analyst	150	NC

General Provider Information

NPI Number	:	1972858165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HENDERSON PH.D., LBA, BCBA-D

Provider Business Mailing Address
First Line	:	3911 WRIGHTSVILLE AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6225
Country	:	US
Telephone Number	:	866-498-5367
Fax Number	:

Provider Business Practice Location Address
First Line	:	3911 WRIGHTSVILLE AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6225
Country	:	US
Telephone Number	:	866-498-5367
Fax Number	:

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

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	10/09/2025

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