Provider Demographics
NPI:1124536164
Name:CHRISS BENAY WETHERINGTON
Entity Type:Organization
Organization Name:CHRISS BENAY WETHERINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISS
Authorized Official - Middle Name:BENAY
Authorized Official - Last Name:WETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-691-4538
Mailing Address - Street 1:1 COVEWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704
Mailing Address - Country:US
Mailing Address - Phone:305-742-1377
Mailing Address - Fax:
Practice Address - Street 1:1 COVEWOOD CT
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-3011
Practice Address - Country:US
Practice Address - Phone:305-742-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0105541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811374366Medicaid