Provider Demographics
NPI:1225637796
Name:VERDOORN, CINDY (LCAS)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:VERDOORN
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 RAINFORD CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4119
Mailing Address - Country:US
Mailing Address - Phone:704-252-1012
Mailing Address - Fax:
Practice Address - Street 1:10831 PINEVILLE RD UNIT 9
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8137
Practice Address - Country:US
Practice Address - Phone:980-579-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20635101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)