Provider Demographics
NPI:1497227789
Name:WARE, CYNTHIA NICHOLE (LPCA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NICHOLE
Last Name:WARE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 PEDIGO WAY STE 30
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6124
Mailing Address - Country:US
Mailing Address - Phone:270-495-1224
Mailing Address - Fax:270-599-0023
Practice Address - Street 1:1043 PEDIGO WAY STE 30
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6124
Practice Address - Country:US
Practice Address - Phone:270-495-1224
Practice Address - Fax:270-599-0023
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246020101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional