| Doctor Name: | CONSTANCE M. HENDERSON |
| NPI Number: | 1629166475 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W. |
| License Number: | LCS 18786 |
| Business Practice Address: | 549 Old Mammoth Road, Suite 10 Mammoth Lakes, CA - 935460000 |
| Business Phone Number: | 7609344400 |
| Business Fax Number: | |
| Mailing Address: | Po Box 284, LEE VINING |
| State: | CA |
| Postal Code: | 935410284 |
| Phone Number: | 7609344400 |
| Fax Number: | |
| NPI Enumeration Date: | 10/10/2006 |
| NPI Last Update Date: | 02/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS 18786 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |