Provider Demographics
NPI:1659945111
Name:MATHIS, CINDY (LPC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 N OAK STREET EXT BLDG D
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1066
Mailing Address - Country:US
Mailing Address - Phone:229-244-2030
Mailing Address - Fax:
Practice Address - Street 1:3312 N OAK STREET EXT BLDG D
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1066
Practice Address - Country:US
Practice Address - Phone:229-244-2030
Practice Address - Fax:229-244-2038
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012198101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional