Individual
LAKISHA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED NURSE
Contact information
Practice address
2619 S. LANCASTER RD, DALLAS, TX 75216
(214) 376-7388
(214) 376-7899
Mailing address
3543 RIO GRANDE CIR, DALLAS, TX 75233-2553
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
300712
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300712
LVN
TX
Enumeration date
07/15/2013
Last updated
04/21/2020
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