Provider Demographics
NPI:1770631806
Name:STUART-WHITE, CYNTHIA LOIS (MA, LPCC, LPAT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOIS
Last Name:STUART-WHITE
Suffix:
Gender:F
Credentials:MA, LPCC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11024 MONTGOMERY BLVD NE # 105
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3962
Mailing Address - Country:US
Mailing Address - Phone:505-385-8305
Mailing Address - Fax:
Practice Address - Street 1:7312 ARVADA AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4513
Practice Address - Country:US
Practice Address - Phone:505-385-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0068162101Y00000X
NM258843101YS0200X
NMCAT0068162221700000X
NMCCMH0173561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist