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General NPI Number Information
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NPI Number | 1801238464
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Entity Type | Individual
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Provider Name | CYNTHIA MICHELLE SOLECKI PSY.D
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Gender | Female
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 400 S PINETREE BLVD
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City | THOMASVILLE
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State | GA
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Zip | 31792-7128
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Country | US
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Telephone | 352-239-1961
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Fax |
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Provider Business Mailing Address
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Address Line | 5165 CYPRESS DR
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City | LAKE PARK
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State | GA
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Zip | 31636-3141
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Country | US
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Telephone | 352-239-1961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY8222
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License Number State | FL
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