Provider Demographics
NPI:1265818769
Name:CHAUSSE, CYNTHIA LEE (EDD, LMHC LPC)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:CHAUSSE
Suffix:
Gender:F
Credentials:EDD, LMHC LPC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LEE
Other - Last Name:NIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:22 GILMER LN
Mailing Address - Street 2:SOUL CARE SOLUTION
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-5173
Mailing Address - Country:US
Mailing Address - Phone:941-815-0950
Mailing Address - Fax:
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2978
Practice Address - Country:US
Practice Address - Phone:941-815-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA070100785101YM0800X, 101YP2500X
FLMH3566101YP2500X, 101YM0800X
FL101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070100785OtherLPC
FLMH3566OtherMENTAL HEALTH LICENSE