Provider Demographics
NPI:1861920019
Name:HENSON, CRISTINA ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELIZABETH
Last Name:HENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:ELIZABETH
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 WILTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-8808
Mailing Address - Country:US
Mailing Address - Phone:336-489-0924
Mailing Address - Fax:
Practice Address - Street 1:17 E BUCK MOUNTAIN ROAD
Practice Address - Street 2:UNIT A
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-2869
Practice Address - Country:US
Practice Address - Phone:336-479-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0125791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical