Doctor Name: | MATTHEW JAMAL HENDERSON |
NPI Number: | 1831543065 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 6375 S Williamson Blvd Apt #733 Port Orange, FL - 321284010 |
Business Phone Number: | 9546437740 |
Business Fax Number: | |
Mailing Address: | 6375 S Williamson Blvd, Apt #733 PORT ORANGE |
State: | FL |
Postal Code: | 321284010 |
Phone Number: | 9546437740 |
Fax Number: | |
NPI Enumeration Date: | 04/13/2016 |
NPI Last Update Date: | 04/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |