Provider Demographics
NPI:1093158701
Name:WANAMAKER, CINDY JO (LPC)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:JO
Last Name:WANAMAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3843
Mailing Address - Country:US
Mailing Address - Phone:304-366-7174
Mailing Address - Fax:304-366-7419
Practice Address - Street 1:448 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3843
Practice Address - Country:US
Practice Address - Phone:304-366-7174
Practice Address - Fax:304-366-7419
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional