Provider Demographics
NPI:1619136116
Name:LENEHAN, CYNTHIA C
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:LENEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:C
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5153 POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4133
Mailing Address - Country:US
Mailing Address - Phone:843-557-4309
Mailing Address - Fax:
Practice Address - Street 1:4400A MARBLEHEAD LN
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-3221
Practice Address - Country:US
Practice Address - Phone:843-557-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC5316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid