Provider Demographics
NPI:1487964938
Name:HENDERSON, MELISSA DELLA (MSW,LISW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DELLA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSW,LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 WROTHSTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9246
Mailing Address - Country:US
Mailing Address - Phone:614-851-9910
Mailing Address - Fax:
Practice Address - Street 1:6160 WROTHSTON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9246
Practice Address - Country:US
Practice Address - Phone:614-851-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00086311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical