Provider Demographics
NPI:1427819077
Name:VEAL, CYNTHIA MARIE LOUISE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE LOUISE
Last Name:VEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:
Other - Last Name:VEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:807 HERRONS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4593
Mailing Address - Country:US
Mailing Address - Phone:803-412-9118
Mailing Address - Fax:
Practice Address - Street 1:807 HERRONS FERRY RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4593
Practice Address - Country:US
Practice Address - Phone:803-412-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC272416174400000X
SC7000346532251B00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No174400000XOther Service ProvidersSpecialist
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7000346532OtherSOUTH CAROLINA STATE PROCUREMENT OFFICE