Provider Demographics
NPI:1871124768
Name:HENDERSON, ANDREW TODD (LPC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:TODD
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21555 PARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9064
Mailing Address - Country:US
Mailing Address - Phone:734-756-3815
Mailing Address - Fax:248-476-7403
Practice Address - Street 1:1 DETROIT METRO AIRPORT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48242-1004
Practice Address - Country:US
Practice Address - Phone:734-247-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4764124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional