Provider Demographics
NPI:1346984770
Name:PAYNE, CYNTHIA C
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HURT
Mailing Address - State:VA
Mailing Address - Zip Code:24563-3006
Mailing Address - Country:US
Mailing Address - Phone:434-238-0169
Mailing Address - Fax:
Practice Address - Street 1:1555 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-7351
Practice Address - Country:US
Practice Address - Phone:434-338-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional