Provider Demographics
NPI:1558504035
Name:KONG, CYNTHIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 CASTRO STREET, #2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3236
Mailing Address - Country:US
Mailing Address - Phone:415-285-1987
Mailing Address - Fax:
Practice Address - Street 1:1246 CASTRO STREET, #2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3236
Practice Address - Country:US
Practice Address - Phone:415-285-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist