Healthcare Provider Details

I. General information

NPI: 1316355522
Provider Name (Legal Business Name): CYNTHIA DIGGS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 PHEASANT CT
MACHIPONGO VA
23405-2434
US

IV. Provider business mailing address

3177 PHEASANT CT
MACHIPONGO VA
23405-2434
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-7690
  • Fax: 757-442-7692
Mailing address:
  • Phone: 757-442-7690
  • Fax: 757-442-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004307
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: