Basic Information
| Provider Information | |||||||||
| NPI: | 1801136189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNDON | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | LCSW, LCAS, CSI | ||||||||
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| Mailing Information | |||||||||
| Address1: | CALLER BOX C-268 | ||||||||
| Address2: | |||||||||
| City: | CHEROKEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284979163 | ||||||||
| FaxNumber: | 8284976977 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 SEQUOYAH TRL | ||||||||
| Address2: | |||||||||
| City: | CHEROKEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284976892 | ||||||||
| FaxNumber: | 8284976977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2013 | ||||||||
| LastUpdateDate: | 07/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-14842 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | C007957 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.