Provider Demographics
NPI:1144082991
Name:HENCKEN, CHRISTINA EILEEN (ATR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:EILEEN
Last Name:HENCKEN
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7451
Mailing Address - Country:US
Mailing Address - Phone:302-559-8485
Mailing Address - Fax:
Practice Address - Street 1:326 H STREET CAMP LEJEUNE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28547-7451
Practice Address - Country:US
Practice Address - Phone:302-559-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-591221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist