Basic Information
| Provider Information | |||||||||
| NPI: | 1164742672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | JOHNSON | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORDTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281392502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282877945 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 190 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORDTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281392502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282877945 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2010 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C001099 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6007612 | 05 | NC | MEDICAID | Q41077A | 01 | NC | MEDICARE PTAN | OTHER |