Provider Demographics
NPI:1336390988
Name:WARD, CYNTHIA MAYNARD (PSYD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MAYNARD
Last Name:WARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E CROSSVILLE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3093
Mailing Address - Country:US
Mailing Address - Phone:404-823-1660
Mailing Address - Fax:
Practice Address - Street 1:515 E CROSSVILLE RD STE 210
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3093
Practice Address - Country:US
Practice Address - Phone:404-823-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
GAPS-T001034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program