Provider Demographics
NPI:1881987204
Name:HENDERSON, KRISTINA (LPC, CRC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204
Mailing Address - Country:US
Mailing Address - Phone:678-359-5585
Mailing Address - Fax:
Practice Address - Street 1:419 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204
Practice Address - Country:US
Practice Address - Phone:678-359-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional