Basic Information
| Provider Information | |||||||||
| NPI: | 1942589031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 COURT ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245041312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344858866 | ||||||||
| FaxNumber: | 4344858877 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 COURT ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245041312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344858866 | ||||||||
| FaxNumber: | 4344858877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2011 | ||||||||
| LastUpdateDate: | 08/08/2011 | ||||||||
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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 | 101YP2500X | 0701004266 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1871542340 | 05 | VA | MEDICAID |