Active NPI
Carol Henderson, LICDC
- Addiction (Substance Use Disorder) Counselor
- Cortland, OH
National Provider Identifier
1780036079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LICDC933722
- Practice address
- 3194 Deer TRL Unit B
Cortland, OH 44410-9113 - Phone
- (330) 502-8875
- NPI assigned
- Jul 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S0013966 | OH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LICDC933722 | OH | Primary |
Addresses
Primary practice location
3194 Deer TRL Unit B
Cortland, OH 44410-9113
Mailing address
3194 Deer TRL Unit B
Cortland, OH 44410-9113
Phone (330) 502-8875
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICDC933722 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| S0013966 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643328000000",
"number": "1780036079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3194 DEER TRL UNIT B",
"city": "CORTLAND",
"state": "OH",
"postal_code": "444109113",
"telephone_number": "330-502-8875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3194 DEER TRL UNIT B",
"city": "CORTLAND",
"state": "OH",
"postal_code": "444109113",
"telephone_number": "330-502-8875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "CAROL",
"name_prefix": "Mrs.",
"credential": "LICDC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-11",
"last_updated": "2022-01-28",
"certification_date": "2022-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S0013966",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "LICDC933722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cortland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.