Provider Demographics
NPI:1730607177
Name:HENDERSON, CHRISTINE DURBIN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DURBIN
Last Name:HENDERSON
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 1:25701 N LAKELAND BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2453
Mailing Address - Country:US
Mailing Address - Phone:440-865-0364
Mailing Address - Fax:
Practice Address - Street 1:1941 SAGAMORE DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2314
Practice Address - Country:US
Practice Address - Phone:216-486-2999
Practice Address - Fax:216-486-3951
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17005501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical