Provider Demographics
NPI:1124502661
Name:HENDRA, BETHANY A
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:HENDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-2100
Mailing Address - Country:US
Mailing Address - Phone:336-224-1919
Mailing Address - Fax:336-224-1929
Practice Address - Street 1:310 MURPHY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-2100
Practice Address - Country:US
Practice Address - Phone:336-224-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician