Provider Demographics
NPI:1750574273
Name:BOATWRIGHT, CYNTHIA (LPC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:BOATWRIGHT
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 1:1037 CHUCK DAWLEY BLVD BLDG D
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4146
Mailing Address - Country:US
Mailing Address - Phone:843-697-7817
Mailing Address - Fax:
Practice Address - Street 1:1037 CHUCK DAWLEY BLVD BLDG D
Practice Address - Street 2:SUITE 206
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4146
Practice Address - Country:US
Practice Address - Phone:843-697-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional