Provider Demographics
NPI:1427862226
Name:HENDERSON, TYTRICE AMICA
Entity type:Individual
Prefix:
First Name:TYTRICE
Middle Name:AMICA
Last Name:HENDERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 L'ENFANT SQUARE SE,
Mailing Address - Street 2:
Mailing Address - City:WASSHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020
Mailing Address - Country:US
Mailing Address - Phone:202-213-2835
Mailing Address - Fax:
Practice Address - Street 1:1301 L'ENFANT SQUARE SE,
Practice Address - Street 2:
Practice Address - City:WASSHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-213-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant