Provider Demographics
NPI:1659935856
Name:CRISSINGER, RIA (LCMHCA)
Entity Type:Individual
Prefix:
First Name:RIA
Middle Name:
Last Name:CRISSINGER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 SPRING BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0120
Mailing Address - Country:US
Mailing Address - Phone:803-412-1312
Mailing Address - Fax:
Practice Address - Street 1:1816 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2416
Practice Address - Country:US
Practice Address - Phone:704-313-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional