Provider Demographics
NPI:1639845134
Name:HENDERSHOT, CHRISTIAN SULLIVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:SULLIVAN
Last Name:HENDERSHOT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MANNING DR # 4007
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-6117
Mailing Address - Country:US
Mailing Address - Phone:919-400-3024
Mailing Address - Fax:
Practice Address - Street 1:1101 WEAVER DAIRY RD # 102-103
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1791
Practice Address - Country:US
Practice Address - Phone:984-974-6320
Practice Address - Fax:984-974-6447
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6019103T00000X
NCPENDING103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist