Provider Demographics
NPI:1518242379
Name:RODGERS, CYNTHIA (LMBT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8333
Mailing Address - Country:US
Mailing Address - Phone:704-492-0544
Mailing Address - Fax:
Practice Address - Street 1:959 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8333
Practice Address - Country:US
Practice Address - Phone:704-492-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist