Provider Demographics
NPI:1386707594
Name:HENDERSON, DANA HUGHES (PHD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:HUGHES
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 1:2952 VININGS FOREST WAY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4222
Mailing Address - Country:US
Mailing Address - Phone:404-247-9274
Mailing Address - Fax:770-434-8830
Practice Address - Street 1:2952 VININGS FOREST WAY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4222
Practice Address - Country:US
Practice Address - Phone:404-247-9274
Practice Address - Fax:770-434-8830
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001261103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01000583OtherAMERIGROUP
GA00477837AMedicaid
GA01000583OtherAMERIGROUP
GA41504Medicare UPIN