Provider Demographics
NPI:1225265317
Name:CLARK, CYNTHIA DELANEY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DELANEY
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 JAMESTOWN RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-220-8550
Mailing Address - Fax:
Practice Address - Street 1:1769 JAMESTOWN RD
Practice Address - Street 2:SUITE 114
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-220-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000093106H00000X
FLMT1331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist