Individual
BREANA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-8970
(909) 825-7084
Mailing address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
117728
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117728
CALIFORNIA BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
07/02/2021
Last updated
03/12/2025
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