Provider Demographics
NPI:1538894233
Name:HENDERSON, CARLTON JERMAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:JERMAINE
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42034
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-2034
Mailing Address - Country:US
Mailing Address - Phone:804-322-7185
Mailing Address - Fax:
Practice Address - Street 1:5328 HUNT MASTER DR APT A
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2765
Practice Address - Country:US
Practice Address - Phone:804-322-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor