Provider Demographics
NPI:1689214439
Name:AGBAYANI, CYNTHIA JOAN (LPC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JOAN
Last Name:AGBAYANI
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 1:4300A RIDGEWOOD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5307
Mailing Address - Country:US
Mailing Address - Phone:703-580-7210
Mailing Address - Fax:703-580-7213
Practice Address - Street 1:4300A RIDGEWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5307
Practice Address - Country:US
Practice Address - Phone:703-580-7210
Practice Address - Fax:703-580-7213
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205807096Medicaid