Provider Demographics
NPI:1407566847
Name:WHITE, CYNTHIA L (LPCC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:TESUQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87574-0401
Mailing Address - Country:US
Mailing Address - Phone:505-927-2052
Mailing Address - Fax:
Practice Address - Street 1:2356 FOX RD STE 300
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7294
Practice Address - Country:US
Practice Address - Phone:505-927-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0823101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional