MEDICARE: MRS. CYNTHIA LEA MINTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701005982	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619261286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA LEA MINTO

Provider Business Mailing Address
First Line	:	14525 WOODLEIGH DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-6587
Country	:	US
Telephone Number	:	804-748-6401
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 HEMLOCK AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1328
Country	:	US
Telephone Number	:	804-931-1182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	08/03/2020

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