Provider Demographics
NPI:1184937765
Name:GLADYNESS, CYNTHIA LAVERNE (LMSW,ACSW,CAAC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LAVERNE
Last Name:GLADYNESS
Suffix:
Gender:F
Credentials:LMSW,ACSW,CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 ALEXANDER ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3384
Mailing Address - Country:US
Mailing Address - Phone:616-485-9021
Mailing Address - Fax:
Practice Address - Street 1:1443 ALEXANDER ST. SE
Practice Address - Street 2:
Practice Address - City:GRADN RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-485-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010780521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical