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Individual

CHARLESETTA LADINA HENDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
15902 FORDHAM ST, DETROIT, MI 48205-2948
(313) 658-4480
Mailing address
15902 FORDHAM ST, DETROIT, MI 48205-2948

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
247200000XTECHNICIAN
MI

Other

Enumeration date
07/05/2016
Last updated
07/05/2016
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