Provider Demographics
NPI:1285488031
Name:HENDERSON, ALECIA MONIQUE (MS, PLPC)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:MONIQUE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 CURTIS LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-5015
Mailing Address - Country:US
Mailing Address - Phone:318-401-8522
Mailing Address - Fax:
Practice Address - Street 1:851 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2136
Practice Address - Country:US
Practice Address - Phone:318-401-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health