Provider Demographics
NPI:1255640017
Name:HENDERSON, KITTY CAUGHMAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KITTY
Middle Name:CAUGHMAN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 PICKENS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3450
Mailing Address - Country:US
Mailing Address - Phone:803-252-3001
Mailing Address - Fax:803-252-0211
Practice Address - Street 1:1615 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3450
Practice Address - Country:US
Practice Address - Phone:803-252-3001
Practice Address - Fax:803-252-0211
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional