Provider Demographics
NPI:1467672147
Name:CYNKAR, KIMM (LISW LICDC)
Entity Type:Individual
Prefix:
First Name:KIMM
Middle Name:
Last Name:CYNKAR
Suffix:
Gender:F
Credentials:LISW LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 WOODSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4159
Mailing Address - Country:US
Mailing Address - Phone:614-519-6025
Mailing Address - Fax:
Practice Address - Street 1:1910 CROWN PARK CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2404
Practice Address - Country:US
Practice Address - Phone:614-457-8359
Practice Address - Fax:614-457-6898
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00088141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical