Provider Demographics
NPI:1922768597
Name:HENDERSON, ELIZABETH YONG (LMSW, LCDC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YONG
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10703 RR 12
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5239
Mailing Address - Country:US
Mailing Address - Phone:949-629-0094
Mailing Address - Fax:
Practice Address - Street 1:26229 N CRANES MILL RD
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-1957
Practice Address - Country:US
Practice Address - Phone:305-100-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15785101YA0400X
TX112349104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)