Provider Demographics
NPI:1114229507
Name:MYERS, CINDY (LISW, LADAC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:LISW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 AMHERST DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1223
Mailing Address - Country:US
Mailing Address - Phone:505-463-8530
Mailing Address - Fax:505-465-0433
Practice Address - Street 1:10 TESUQUE ST
Practice Address - Street 2:
Practice Address - City:KEWA
Practice Address - State:NM
Practice Address - Zip Code:87052-9998
Practice Address - Country:US
Practice Address - Phone:505-465-2733
Practice Address - Fax:505-465-0433
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0160181101YA0400X
NMX-08137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)