Provider Demographics
NPI:1619093978
Name:PEARSON, CYNTHIA (CYNTHIA PEARSON, LAC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:CYNTHIA PEARSON, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 TREADWELL LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-1827
Mailing Address - Country:US
Mailing Address - Phone:703-620-2353
Mailing Address - Fax:703-319-0224
Practice Address - Street 1:303 MAPLE AVE W STE G
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4312
Practice Address - Country:US
Practice Address - Phone:703-319-1994
Practice Address - Fax:703-319-0224
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0121-000190OtherVA ACUPUNCTURIST LICENSE