Provider Demographics
NPI:1073152062
Name:EVERET-SIMPSON, CINDYLOU NONE (ICADC, CAC, CCS)
Entity Type:Individual
Prefix:
First Name:CINDYLOU
Middle Name:NONE
Last Name:EVERET-SIMPSON
Suffix:
Gender:F
Credentials:ICADC, CAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 EAST ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5838
Mailing Address - Country:US
Mailing Address - Phone:203-562-2101
Mailing Address - Fax:203-562-2102
Practice Address - Street 1:311 EAST ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5838
Practice Address - Country:US
Practice Address - Phone:203-562-2101
Practice Address - Fax:203-562-2102
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)