Juderius Henderson, LCAS, LCSW-A

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCAS-25696 Issued in NC

Practice address

305 Dogtrot CT
Fayetteville, NC 28311-8932

Phone

(910) 987-0292

NPI assigned

Aug 10, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1831745405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 S MIAMI BLVD APT 205",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277038288",
            "telephone_number": "910-987-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 DOGTROT CT",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283118932",
            "telephone_number": "910-987-0292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1758 E 11th St Ste E",
            "address_purpose": "LOCATION",
            "city": "Siler City",
            "state": "NC",
            "postal_code": "273442845",
            "country_code": "US",
            "telephone_number": "919-663-3303",
            "fax_number": "919-663-3305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JUDERIUS",
        "credential": "LCAS, LCSW-A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-10",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-25696",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P013818",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David B Henderson, PA
• Dionia R Henderson, OTR/L
• Essence Henderson
• Felicia J Henderson, AAS
• Joseph Bernard Henderson, D.O.
• Karen L Henderson, MT
• Keith Henderson, DO
• Krissa Henderson
• Melaney Henderson
• Melvin Henderson, M.D.

• Addiction (Substance Use Disorder) Counselor in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.