Individual
DIANE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
311 JUDGES RD, 4E, WILMINGTON, NC 28405-3651
(910) 791-6767
(910) 791-6890
Mailing address
1634 MARVELLE AVE, ROCKY MOUNT, NC 27803-2326
(252) 903-9926
(252) 231-1062
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C001733
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40981
BCBS NC
NC
05
—
6003386
—
NC
01
—
62-00248
EVERCARE
—
Enumeration date
08/22/2005
Last updated
01/23/2020
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