Provider Demographics
NPI:1538612080
Name:SPROUSE, CYNTHIA ALLISON (MA/CAS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ALLISON
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:MA/CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BRADY CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 BRADY CT STE A
Practice Address - Street 2:SUITE A
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4574
Practice Address - Country:US
Practice Address - Phone:919-465-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2042103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent