Provider Demographics
NPI:1689001372
Name:WYATT, CINDY MARIE (AOD COUNSLELOR)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:MARIE
Last Name:WYATT
Suffix:
Gender:F
Credentials:AOD COUNSLELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 SOLITUDE WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5143
Mailing Address - Country:US
Mailing Address - Phone:925-813-9910
Mailing Address - Fax:
Practice Address - Street 1:1537 SOLITUDE WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5143
Practice Address - Country:US
Practice Address - Phone:925-813-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)