Individual
GLORI MAE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP,ADMINISTRATOR
Contact information
Practice address
2013 N ARMISTEAD AVE APT E16, HAMPTON, VA 23666-3499
(984) 289-7325
Mailing address
4243 LAKE WOODARD DR, RALEIGH, NC 27604-1071
(984) 289-7325
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0734012512
VA
164W00000X
Licensed Practical Nurse
Primary
76840
NC
164X00000X
Licensed Vocational Nurse
76840
NC
Other
Enumeration date
01/01/2025
Last updated
01/01/2025
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