Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2001018627 | MO |
N | 225C00000X | Rehabilitation Counselor | C-035828 | MO |
NPI | 1275737124 |
---|---|
Provider Name | Ladonna Henson |
First Address | Saint Louis, MO 63146-3402 |
Second Address | Saint Louis, MO 63146-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 08/07/2007 |