Provider Demographics
NPI:1396952891
Name:JOLLY, CYNTHIA (RC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:RC
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:JO
Other - Last Name:JOLLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RC
Mailing Address - Street 1:2905A HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3821
Mailing Address - Country:US
Mailing Address - Phone:425-359-4161
Mailing Address - Fax:424-513-2466
Practice Address - Street 1:2905A HEWITT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3821
Practice Address - Country:US
Practice Address - Phone:425-359-4161
Practice Address - Fax:424-513-2466
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00049274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health