Provider Demographics
NPI:1922157353
Name:BURDETTE, CINDY G (MA)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:G
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LANCELOT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403
Mailing Address - Country:US
Mailing Address - Phone:304-263-2490
Mailing Address - Fax:304-263-2490
Practice Address - Street 1:1105 NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:364-263-2490
Practice Address - Fax:304-263-2490
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional