Dominique Henderson

NPI #1780138230 in Bastrop, Louisiana

Provider Information

NPI Number: 1780138230
Entity Type: Individual
Name: Dominique Henderson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Enumeration Date: Aug 12, 2016
Last Updated: Aug 12, 2016

Practice Location

Address: 209 W JEFFERSON AVE
City: Bastrop
State: Louisiana
ZIP Code: 71220-4543
Phone: (318) 239-3890

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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