Provider Demographics
NPI:1164933693
Name:BRUSHART, CYNTHIA (CDCA, RA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BRUSHART
Suffix:
Gender:F
Credentials:CDCA, RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14572 US RT 23
Mailing Address - Street 2:SUITE C
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14572 STATE ROUTE 23
Practice Address - Street 2:SUITE C
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690
Practice Address - Country:US
Practice Address - Phone:740-947-6727
Practice Address - Fax:740-947-6727
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRA161574101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)