Individual
MRS. CAROL HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICDC
Contact information
Practice address
3194 DEER TRL UNIT B, CORTLAND, OH 44410-9113
(330) 502-8875
Mailing address
3194 DEER TRL UNIT B, CORTLAND, OH 44410-9113
(330) 502-8875
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC933722
OH
104100000X
Social Worker
S0013966
OH
Other
Enumeration date
07/11/2016
Last updated
01/28/2022
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