Provider Demographics
NPI:1700226586
Name:HENDERSON, AMANDA J (MS, LCPC, LADC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, LCPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3130
Mailing Address - Country:US
Mailing Address - Phone:702-385-3330
Mailing Address - Fax:
Practice Address - Street 1:323 N MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3130
Practice Address - Country:US
Practice Address - Phone:702-385-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01421101YA0400X
NVPC5752101YM0800X
NVCP5752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health