Provider Demographics
NPI:1013701069
Name:CHRISTENBURY, AUDREY ROY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ROY
Last Name:CHRISTENBURY
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 1:7507 THORNCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6611
Mailing Address - Country:US
Mailing Address - Phone:336-693-8366
Mailing Address - Fax:
Practice Address - Street 1:1133 MILITARY CUTOFF RD STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4403
Practice Address - Country:US
Practice Address - Phone:910-516-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health