Provider Demographics
NPI:1144652553
Name:PORTER, CYNTHIA HENDERSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:HENDERSON
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOPE ROAD, SUITE 111
Mailing Address - Street 2:PMB #246
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7287
Mailing Address - Country:US
Mailing Address - Phone:571-229-0831
Mailing Address - Fax:
Practice Address - Street 1:800 CORPORATE DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4889
Practice Address - Country:US
Practice Address - Phone:571-229-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical