Provider Demographics
NPI:1154726529
Name:VASILAS, CYNTHIA (PHD NCC LCMHS BC-TH)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:VASILAS
Suffix:
Gender:F
Credentials:PHD NCC LCMHS BC-TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1963 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9570
Mailing Address - Country:US
Mailing Address - Phone:704-709-1147
Mailing Address - Fax:980-495-8940
Practice Address - Street 1:2922 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7268
Practice Address - Country:US
Practice Address - Phone:704-709-1147
Practice Address - Fax:980-495-8940
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4797101YP2500X
NC9124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional