Healthcare Provider Details

I. General information

NPI: 1770965386
Provider Name (Legal Business Name): CHRISTINA ROBERTSON HUSSAMI MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 HENRY ST
GREENSBORO NC
27405-3669
US

IV. Provider business mailing address

2703 HENRY ST
GREENSBORO NC
27405-3669
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-8911
  • Fax:
Mailing address:
  • Phone: 336-621-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011175
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: