Provider Demographics
NPI:1235974007
Name:HENSLEY, NISSA C (CSW)
Entity type:Individual
Prefix:
First Name:NISSA
Middle Name:C
Last Name:HENSLEY
Suffix:
Gender:X
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CHINOE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6571
Mailing Address - Country:US
Mailing Address - Phone:859-327-4416
Mailing Address - Fax:855-594-5062
Practice Address - Street 1:1050 CHINOE RD STE 112
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6571
Practice Address - Country:US
Practice Address - Phone:859-327-4416
Practice Address - Fax:855-594-5062
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2592411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical