Provider Demographics
NPI:1245578061
Name:HURST, CHRISTENA LYNN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTENA
Middle Name:LYNN
Last Name:HURST
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 FAIRBURN RD BLDG 4
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2926
Mailing Address - Country:US
Mailing Address - Phone:470-206-5853
Mailing Address - Fax:
Practice Address - Street 1:3464 FAIRBURN RD BLDG 4
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2926
Practice Address - Country:US
Practice Address - Phone:470-206-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000264106H00000X
GAMFT002015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist