Provider Demographics
NPI:1760806962
Name:LEMELIN, CYNTHIA LU (CADC-II-CA, RAS)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LU
Last Name:LEMELIN
Suffix:
Gender:F
Credentials:CADC-II-CA, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3524
Mailing Address - Country:US
Mailing Address - Phone:909-991-3039
Mailing Address - Fax:909-885-6758
Practice Address - Street 1:1115 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3523
Practice Address - Country:US
Practice Address - Phone:909-888-6956
Practice Address - Fax:909-885-6758
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360004BN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)