Provider Demographics
NPI:1265269716
Name:KIRILENKO, CHRISTA MARIE (MSW, CSW)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARIE
Last Name:KIRILENKO
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1112
Mailing Address - Country:US
Mailing Address - Phone:859-583-9715
Mailing Address - Fax:
Practice Address - Street 1:7 WAVELAND AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1231
Practice Address - Country:US
Practice Address - Phone:859-385-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2595711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical