Provider Demographics
NPI:1245542695
Name:HENDERSON, LAURETTA DE'VEAUX (BS, MS)
Entity type:Individual
Prefix:MS
First Name:LAURETTA
Middle Name:DE'VEAUX
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SW 131ST TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5415
Mailing Address - Country:US
Mailing Address - Phone:786-586-0629
Mailing Address - Fax:
Practice Address - Street 1:3500 N STATE ROAD 7
Practice Address - Street 2:SUITE 212
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5600
Practice Address - Country:US
Practice Address - Phone:954-578-8399
Practice Address - Fax:954-578-0145
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health