Provider Demographics
NPI:1215027289
Name:HENDERSON, DAVID T (MED)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PULLER CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7623
Mailing Address - Country:US
Mailing Address - Phone:803-957-9659
Mailing Address - Fax:
Practice Address - Street 1:301-A PALMETTO PARK BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-359-3545
Practice Address - Fax:803-359-2111
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health