Provider Demographics
NPI:1174841142
Name:WINGATE, CYNTHIA C (PCMHT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:WINGATE
Suffix:
Gender:F
Credentials:PCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 SAINT JOHNS AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8725
Mailing Address - Country:US
Mailing Address - Phone:772-205-0432
Mailing Address - Fax:561-516-6211
Practice Address - Street 1:2912 SAINT JOHNS AVE APT 1A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8725
Practice Address - Country:US
Practice Address - Phone:772-205-0432
Practice Address - Fax:561-516-6211
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000817101YM0800X
FLMH 10161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health