Provider Demographics
NPI:1831594886
Name:REAL, CYNTHIA (MED, CSAC-I)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:REAL
Suffix:
Gender:F
Credentials:MED, CSAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36130
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6130
Mailing Address - Country:US
Mailing Address - Phone:704-232-8669
Mailing Address - Fax:
Practice Address - Street 1:7003 WALLACE RD
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6815
Practice Address - Country:US
Practice Address - Phone:704-536-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)