Provider Demographics
NPI:1689415796
Name:HENDERSON, CALIZZIA NICOLE
Entity type:Individual
Prefix:
First Name:CALIZZIA
Middle Name:NICOLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7123 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-4642
Mailing Address - Country:US
Mailing Address - Phone:470-652-7382
Mailing Address - Fax:
Practice Address - Street 1:7123 9TH ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-4642
Practice Address - Country:US
Practice Address - Phone:470-652-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach