Provider Demographics
NPI:1023507654
Name:ROGERS, CYNTHIA JANE (DMIN, LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JANE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DMIN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435A CARLISLE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4802
Mailing Address - Country:US
Mailing Address - Phone:703-674-8628
Mailing Address - Fax:
Practice Address - Street 1:435A CARLISLE DR STE 104
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4802
Practice Address - Country:US
Practice Address - Phone:703-674-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040022951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical