Provider Demographics
NPI:1124572375
Name:HENNIGAN, CHRISTINE L (MS, LPC, LSATP, CSAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:HENNIGAN
Suffix:
Gender:F
Credentials:MS, LPC, LSATP, CSAC
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:HENNIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC, LSATP, CSAC
Mailing Address - Street 1:501 VILLAGE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5657
Mailing Address - Country:US
Mailing Address - Phone:757-992-9291
Mailing Address - Fax:757-656-5658
Practice Address - Street 1:501 VILLAGE AVE STE 204
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5657
Practice Address - Country:US
Practice Address - Phone:757-992-9291
Practice Address - Fax:757-656-5658
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103194101YA0400X
VA0718000273101YA0400X
GALPC009006101YM0800X
VA0701007146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health