| Dana Henderson, Ph.d., P.c. | |
|
2952 Vinings Forest Way Se Atlanta GA 30339-4222 | |
| (404) 247-9274 | |
| (770) 434-8830 |
| Full Name | Dana Henderson, Ph.d., P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2952 Vinings Forest Way Se, Atlanta, Georgia |
| Authorized Official Name and Position | Dana Hughes Henderson (PRESIDENT) |
| Authorized Official Contact | 4042479274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dana Henderson, Ph.d., P.c. 2952 Vinings Forest Way Se Atlanta GA 30339-4222 Ph: (404) 247-9274 | Dana Henderson, Ph.d., P.c. 2952 Vinings Forest Way Se Atlanta GA 30339-4222 Ph: (404) 247-9274 |
| NPI Number | 1063748283 |
|---|---|
| Provider Enumeration Date | 10/22/2009 |
| Last Update Date | 10/22/2009 |
| Medicare PECOS PAC ID | 6103080015 |
|---|---|
| Medicare Enrollment ID | O20120605000500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063748283 | NPI | - | NPPES |
| 000477837A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | PSY001261 (Georgia) | Primary |
| Provider Name | Dana Hughes Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386707594 PECOS PAC ID: 8628232535 Enrollment ID: I20120605000552 |
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