MR. REGINALD QUENTINE HENDERSON SR. (NPI# 1811149099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811149099 |
| Entity Type | Individual |
| Full Name | MR. REGINALD QUENTINE HENDERSON SR. |
| Credential | CSAC-I |
| Practice Address |
3622 Lyckan Pkwy Ste 6008 Durham NC 27707-2570 |
| Mailing Address |
1613 Bivins St Durham NC 27707-1523 |
| Practice Telephone | 9193816816 |
| Practice Fax Number | 9193816818 |
| Mailing Telephone | 9192249458 |
| Enumeration Date | 2008-10-19 |
| Last Update Date | 2009-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811429335 | Reginald Henderson Sr. | Behavior Technician | 2525 Sw Kenilworth St, Port Saint Lucie, FL 34953-2575 | 2017-04-03 |
| Street Address |
3622 LYCKAN PKWY STE 6008 |
| City | DURHAM |
| State | NC |
| Zip Code | 27707-2570 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912946930 | Onuorah Nwogalanya | Social Worker | 3622 Lyckan Pkwy Ste 6008, Durham, NC 27707-2570 | 2006-06-05 |
| 1144526526 | Sherita Crews | Counselor | 3622 Lyckan Pkwy Ste 6008, Durham, NC 27707-2570 | 2011-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538785928 | Ceara Smith | Social Worker | 1415 W Nc 54 Buidling 200, Suite 111, Durham, NC 27707 | 2020-06-22 |
| 1114554094 | Lauren Michelle Grosse | Physician Assistant | Fastmed Urgent Care 7010 Nc-751, Durham, NC 27707 | 2020-03-23 |
| 1386289635 | Ashley Bailey | Counselor | 1801 Fayetteville Street, Durham, NC 27707 | 2019-11-11 |
| 1881249886 | Erin Ramona Leger | Physical Therapist | 3706 Mayfair St, Ste 120, Durham, NC 27707 | 2019-08-06 |
| 1417417262 | Carmen Elisabeth Sanchez | Psychologist | 3326 Durham Chapel Hill Blvd Bldg D, Durham, NC 27707 | 2019-03-20 |
| 1477026144 | Pope Behavioral Health and Wellness | Counselor | 5102 Chapel Hill Durham Blvd., Suite 101, Durham, NC 27707 | 2019-01-06 |
| 1043780778 | Jessica Ann Revels | Counselor | 1415 West North Carolina 54, Building 100 Suite # 204, Durham, NC 27707 | 2018-11-26 |
| 1558830125 | Michael Brown | Counselor | 1502 W Nc-54, Suite 505, Durham, NC 27707 | 2018-11-13 |
| 1780152827 | Cassandra Gerwig Shaw | Registered Nurse | 5324 Mcfarland Dr Ste 310, Durham, NC 27707 | 2018-11-07 |
| 1942776232 | Lisa J Keskitalo | Physical Therapist | 3708 Mayfair St Ste 120, Durham, NC 27707 | 2018-10-15 |
| Find all providers in zip 27707 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927723 | Irene Dormenie Jackson | Counselor | 904 Woodgreen Dr, Durham, NC 27704-6034 | 2020-09-18 |
| 1285252379 | Chrissteller Taylor | Counselor | 4808 Fortunes Ridge Dr, Durham, NC 27713-9348 | 2020-07-06 |
| 1376169482 | Livia Corry | Counselor | 2410 Presidential Dr Ste 105, Durham, NC 27703-8021 | 2020-06-24 |
| 1639723794 | Philip Marschall | Counselor | 3003 Corinth Ln, Durham, NC 27704-3271 | 2019-07-27 |
| 1497317887 | Francisco Javier Contreras Hernandez | Counselor | 2020 Chapel Hill Rd, Durham, NC 27707-1184 | 2019-07-05 |
| 1235696378 | Aleesha Hughes | Counselor | 2609 N Duke St Ste 403, Durham, NC 27704-3048 | 2019-02-25 |
| 1629569280 | Nyesha Shanta Robinson | Counselor | 2530 Meridian Pkwy Ste 2055, Durham, NC 27713-5272 | 2018-05-19 |
| 1588166243 | Shane Phillips | Counselor | 411 Trent Drive, Durham, NC 27710-0001 | 2018-03-08 |
| 1366954356 | Jamie Lee Washington | Counselor | 2310 S Miami Blvd Ste 136, Durham, NC 27703-5799 | 2017-10-30 |
| 1508381369 | Lacrisha Holcomb | Counselor | 1822 East Highway 54, Suite 300, Durham, NC 27713 | 2017-08-13 |
| Find all providers in DURHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.