Provider Demographics
NPI:1013354125
Name:PARK, CYNTHIA BRYANT (LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:BRYANT
Last Name:PARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13560 COGBURN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3648
Mailing Address - Country:US
Mailing Address - Phone:703-888-7263
Mailing Address - Fax:
Practice Address - Street 1:13560 COGBURN RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-3648
Practice Address - Country:US
Practice Address - Phone:703-888-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006987101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist