Provider Demographics
NPI:1902074917
Name:ROBINSON, CYNTHIA ALICIA (LPC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ALICIA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BYRAM DR APT 803
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-3508
Mailing Address - Country:US
Mailing Address - Phone:601-701-8810
Mailing Address - Fax:
Practice Address - Street 1:350 BYRAM DR APT 803
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-3508
Practice Address - Country:US
Practice Address - Phone:601-701-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid