Provider Demographics
NPI:1770185209
Name:FONDA, CYNTHIA LELAND (LMHC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LELAND
Last Name:FONDA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:LELAND
Other - Last Name:FONDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:15985 PRESERVE MARKETPLACE BLVD # 71
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-5509
Mailing Address - Country:US
Mailing Address - Phone:352-678-5550
Mailing Address - Fax:352-678-5551
Practice Address - Street 1:4800 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5609
Practice Address - Country:US
Practice Address - Phone:727-483-5912
Practice Address - Fax:352-678-5551
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18724101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health