Individual
MISS RUSSELL LEE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
175 EMERY HWY, MACON, GA 31217-3692
(478) 751-4446
(478) 751-4444
Mailing address
175 EMERY HWY, MACON, GA 31217-3692
(478) 751-4446
(478) 751-4444
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW001731
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW001731
LCSW
GA
Enumeration date
06/28/2007
Last updated
07/08/2007
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