Provider Demographics
NPI:1275316440
Name:RALSTON, CINDY DALE (CSW)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:DALE
Last Name:RALSTON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 US 31W BYP STE 12
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4905
Mailing Address - Country:US
Mailing Address - Phone:270-782-0120
Mailing Address - Fax:
Practice Address - Street 1:600 US 31W BYP STE 12
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4905
Practice Address - Country:US
Practice Address - Phone:270-782-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker