Provider Demographics
NPI:1437415866
Name:JAMISON, CYNTHIA LARDELL (LPC, LCADC, MAC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LARDELL
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LPC, LCADC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6703 JAMES FARMER WAY
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2150
Mailing Address - Country:US
Mailing Address - Phone:301-350-3931
Mailing Address - Fax:301-324-4808
Practice Address - Street 1:909 43RD PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3713
Practice Address - Country:US
Practice Address - Phone:202-399-1107
Practice Address - Fax:202-399-1778
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA359101YA0400X
DCPRC16101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)