Provider Demographics
NPI:1104600915
Name:WHITE, CYNTHIA A (MS,LPCA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS,LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CAMP MOWEEN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-2704
Mailing Address - Country:US
Mailing Address - Phone:860-579-3875
Mailing Address - Fax:
Practice Address - Street 1:37 CAMP MOWEEN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:CT
Practice Address - Zip Code:06249-2704
Practice Address - Country:US
Practice Address - Phone:860-579-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional