Provider Demographics
NPI:1437276912
Name:ROBERTS, CYNTHIA DIANNE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:DIANNE
Other - Last Name:HAIRSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:285 SUMMIT VIEW AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-8609
Mailing Address - Country:US
Mailing Address - Phone:386-451-0684
Mailing Address - Fax:
Practice Address - Street 1:160 CYPRESS POINT PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8433
Practice Address - Country:US
Practice Address - Phone:386-585-4645
Practice Address - Fax:386-276-3474
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12217101YM0800X
ORC8241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH12217OtherSTATE LICENSE
ORC8241OtherLICENSE