Provider Demographics
NPI:1801781943
Name:HAM, CHRISOLA (QP, MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:CHRISOLA
Middle Name:
Last Name:HAM
Suffix:
Gender:F
Credentials:QP, MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:ELM CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27822-0381
Mailing Address - Country:US
Mailing Address - Phone:252-361-6835
Mailing Address - Fax:
Practice Address - Street 1:505 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5616
Practice Address - Country:US
Practice Address - Phone:252-212-5524
Practice Address - Fax:252-212-5844
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0218321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical