Healthcare Provider Details

I. General information

NPI: 1588439814
Provider Name (Legal Business Name): CINMARCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 BILLINGSGATE CIR STE A
HENRICO VA
23238-4243
US

IV. Provider business mailing address

9702 GAYTON RD # 219
HENRICO VA
23238-4907
US

V. Phone/Fax

Practice location:
  • Phone: 804-938-9898
  • Fax: 804-509-2403
Mailing address:
  • Phone: 804-938-9898
  • Fax: 804-509-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA FREY
Title or Position: PRACTITIONER
Credential:
Phone: 804-928-5830