Provider Demographics
NPI:1730580903
Name:HENDERSON, MICHELLE CHRISTINE (MA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:CHRISTINE
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:18221 102ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3466
Mailing Address - Country:US
Mailing Address - Phone:425-375-1704
Mailing Address - Fax:
Practice Address - Street 1:18221 102ND AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3466
Practice Address - Country:US
Practice Address - Phone:425-375-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health