Provider Demographics
NPI:1396514923
Name:SAMPLE, CINDY (PHD)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 LEESBURG PIKE STE 740
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-7700
Mailing Address - Country:US
Mailing Address - Phone:703-397-7680
Mailing Address - Fax:
Practice Address - Street 1:8150 LEESBURG PIKE STE 740
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7700
Practice Address - Country:US
Practice Address - Phone:703-397-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health