Provider Demographics
NPI:1154949170
Name:CHRISINGER, MARK (LCMHC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CHRISINGER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5062 SILAS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5962
Mailing Address - Country:US
Mailing Address - Phone:336-462-8785
Mailing Address - Fax:
Practice Address - Street 1:5062 SILAS CREEK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5962
Practice Address - Country:US
Practice Address - Phone:336-462-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15789101YM0800X
NC15789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health