Provider Demographics
NPI:1609856137
Name:CRUTHIRDS, CYNTHIA C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:C
Last Name:CRUTHIRDS
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 1:11601 OLD BILOXI RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39565-7743
Mailing Address - Country:US
Mailing Address - Phone:228-392-5099
Mailing Address - Fax:
Practice Address - Street 1:500 FISHER ST
Practice Address - Street 2:81 MDOS SGOW
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-376-3469
Practice Address - Fax:228-377-8468
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC63371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical