Provider Demographics
NPI:1326066853
Name:SLAUGHTER, CYNTHIA G (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:G
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CINDY
Other - Middle Name:G
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2500 RIKE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3937
Mailing Address - Country:US
Mailing Address - Phone:870-534-1834
Mailing Address - Fax:870-534-5798
Practice Address - Street 1:612 E ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-4842
Practice Address - Country:US
Practice Address - Phone:870-628-4181
Practice Address - Fax:870-628-5369
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-2471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00185236Medicaid
5S052OtherBLUE CROSS BLUE SHIELD
AR5S0526979Medicare PIN