Provider Demographics
NPI:1962177402
Name:DARR, CYNTHIA (SUDPT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DARR
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S HILLHURST RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9063
Mailing Address - Country:US
Mailing Address - Phone:360-857-0007
Mailing Address - Fax:
Practice Address - Street 1:888 S HILLHURST RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-9063
Practice Address - Country:US
Practice Address - Phone:360-857-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60959626101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)