Healthcare Provider Details

I. General information

NPI: 1194648584
Provider Name (Legal Business Name): KRISTEN MICHELLE HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 CAMBRIDGE BELTWAY DR STE E
CHARLOTTE NC
28273-4354
US

IV. Provider business mailing address

5536 SHERRY LN APT 4308
INDIAN LAND SC
29707-6209
US

V. Phone/Fax

Practice location:
  • Phone: 704-799-6824
  • Fax:
Mailing address:
  • Phone: 704-651-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: