Provider Demographics
NPI:1770294399
Name:HUSE, CHRISTINE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:ELIZABETH
Other - Last Name:HUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3977 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8863
Mailing Address - Country:US
Mailing Address - Phone:757-404-8034
Mailing Address - Fax:
Practice Address - Street 1:505 S INDEPENDENCE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1150
Practice Address - Country:US
Practice Address - Phone:757-785-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701013993OtherLICENSED PROFESSIONAL COUNSELOR
VA0704015440OtherRESIDENT IN COUNSELING