Provider Demographics
NPI:1942391834
Name:KIDD, CYNTHIA PARKER (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:PARKER
Last Name:KIDD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VEAZEY ROAD
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1626
Mailing Address - Country:US
Mailing Address - Phone:919-764-2362
Mailing Address - Fax:919-764-2274
Practice Address - Street 1:300 VEAZEY ROAD
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1626
Practice Address - Country:US
Practice Address - Phone:919-764-2362
Practice Address - Fax:919-764-2274
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0009471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical