Provider Demographics
NPI:1730432691
Name:CISNEROS, CYNTHIA DIANE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:DIANE
Other - Last Name:ABERNATHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9379 RUSTLING LEAF
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5212
Mailing Address - Country:US
Mailing Address - Phone:410-812-0738
Mailing Address - Fax:
Practice Address - Street 1:6950 COLUMBIA GATEWAY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2706
Practice Address - Country:US
Practice Address - Phone:410-953-1874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional