Individual
THERESA E HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPRP, CRPS
Contact information
Practice address
2257 SANDY CT, ORANGE PARK, FL 32073-5235
(904) 314-2060
Mailing address
2257 SANDY CT, ORANGE PARK, FL 32073-5235
(904) 314-2060
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12768
FLORIDA BOARD OF CERTIFICATION
FL
Enumeration date
09/17/2018
Last updated
09/17/2018
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