Healthcare Provider Details

I. General information

NPI: 1659945111
Provider Name (Legal Business Name): CINDY MATHIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 N OAK STREET EXT BLDG D
VALDOSTA GA
31605-1066
US

IV. Provider business mailing address

3312 N OAK STREET EXT BLDG D
VALDOSTA GA
31605-1066
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-2030
  • Fax: 229-244-2038
Mailing address:
  • Phone: 229-244-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012198
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: