Provider Demographics
NPI:1619261286
Name:MINTO, CYNTHIA LEA
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEA
Last Name:MINTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14525 WOODLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6587
Mailing Address - Country:US
Mailing Address - Phone:804-748-6401
Mailing Address - Fax:
Practice Address - Street 1:3600 HEMLOCK AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1328
Practice Address - Country:US
Practice Address - Phone:804-931-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA160Medicaid