Provider Demographics
NPI:1306877675
Name:HENDERSON, ANNE ATKINSON (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ATKINSON
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2713
Mailing Address - Country:US
Mailing Address - Phone:601-835-3306
Mailing Address - Fax:601-835-3342
Practice Address - Street 1:115 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2713
Practice Address - Country:US
Practice Address - Phone:601-835-3306
Practice Address - Fax:601-835-3342
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30-444103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling