Individual
TINA LUCILLE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
169 SUFFOLK AVE STE 1, RICHLANDS, VA 24641-2434
(276) 821-2260
Mailing address
1981 SCRATCH GRAVEL RD, MARION, VA 24354-7015
(276) 780-4946
Taxonomy
Speciality
Code
Description
License number
State
364SP0813X
Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
Primary
0024178041
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024178041
LICENSE
VA
Enumeration date
08/16/2019
Last updated
08/26/2025
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