Individual
LISA TAMAR HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RASAC II
Contact information
Practice address
306 N 2ND ST, PIEDMONT, MO 63957-1301
(573) 208-5129
(573) 223-7691
Mailing address
306 N 2ND ST, PIEDMONT, MO 63957-1301
(573) 208-5129
(573) 223-7691
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5974
MO
Other
Enumeration date
04/04/2011
Last updated
04/04/2011
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