Healthcare Provider Details

I. General information

NPI: 1992960942
Provider Name (Legal Business Name): LYNETTE CISNEROS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNETTE CISNEROS LMHC

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 S HAYWOOD ST
WAYNESVILLE NC
28786-6703
US

IV. Provider business mailing address

PO BOX 2187
SYLVA NC
28779-2187
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-3973
  • Fax: 828-631-9280
Mailing address:
  • Phone: 828-631-3973
  • Fax: 828-631-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12009
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12009
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: