Provider Demographics
NPI:1366322778
Name:HENDERSON, DAN TOMPKINS JR
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:TOMPKINS
Last Name:HENDERSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W COLEMAN BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3588
Mailing Address - Country:US
Mailing Address - Phone:843-270-1600
Mailing Address - Fax:
Practice Address - Street 1:222 W COLEMAN BLVD STE 122
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3588
Practice Address - Country:US
Practice Address - Phone:843-270-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)