Provider Demographics
NPI:1679209944
Name:WIRSEN, CHRISTINE M
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:WIRSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9531
Mailing Address - Country:US
Mailing Address - Phone:910-250-4734
Mailing Address - Fax:
Practice Address - Street 1:1611 CASTLE HAYNE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-8859
Practice Address - Country:US
Practice Address - Phone:910-251-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0156371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty