Provider Demographics
NPI:1952883209
Name:SCOTT, CYNTHIA S (EDS)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:S
Last Name:SCOTT
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 THOMAS JEFFERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-4836
Mailing Address - Country:US
Mailing Address - Phone:434-589-3666
Mailing Address - Fax:
Practice Address - Street 1:1918 THOMAS JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-4836
Practice Address - Country:US
Practice Address - Phone:434-589-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-518254103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool