Provider Demographics
NPI:1639722606
Name:HOLIFIELD, CYNTHIA GAIL (LMSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAIL
Last Name:HOLIFIELD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-8216
Mailing Address - Country:US
Mailing Address - Phone:850-284-3735
Mailing Address - Fax:
Practice Address - Street 1:3212 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-8216
Practice Address - Country:US
Practice Address - Phone:850-284-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63763104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker