Provider Demographics
NPI:1104355288
Name:HENDERSON-BASSETT, CHRISTINA (LCSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:HENDERSON-BASSETT
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:388 STATE ST STE 340
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3536
Mailing Address - Country:US
Mailing Address - Phone:971-446-1306
Mailing Address - Fax:
Practice Address - Street 1:388 STATE ST STE 340
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3536
Practice Address - Country:US
Practice Address - Phone:971-446-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011194001041C0700X
ORL103621041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500729525Medicaid