Provider Demographics
NPI:1730274481
Name:HENDRICKS, COLINDA ANDERSON (MA)
Entity type:Individual
Prefix:MS
First Name:COLINDA
Middle Name:ANDERSON
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 CHERRY TREE LANE
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:NC
Mailing Address - Zip Code:28615
Mailing Address - Country:US
Mailing Address - Phone:336-385-9595
Mailing Address - Fax:
Practice Address - Street 1:224 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-1131
Practice Address - Country:US
Practice Address - Phone:336-846-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1903103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107113Medicaid
NC135VTOtherBCBS