Provider Demographics
NPI:1477584084
Name:PAINTER-JENKINS, CYNTHIA JUNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JUNE
Last Name:PAINTER-JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1187
Mailing Address - Country:US
Mailing Address - Phone:276-223-3206
Mailing Address - Fax:276-223-3206
Practice Address - Street 1:770 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1187
Practice Address - Country:US
Practice Address - Phone:276-223-3206
Practice Address - Fax:276-223-3206
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945298Medicaid
VA190002053Medicare PIN