Provider Demographics
NPI:1578398202
Name:URRUTIA, CINTHIA
Entity type:Individual
Prefix:
First Name:CINTHIA
Middle Name:
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:URRUTIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2250 REED RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-6248
Mailing Address - Country:US
Mailing Address - Phone:770-366-1961
Mailing Address - Fax:
Practice Address - Street 1:310 N SELVIDGE ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3145
Practice Address - Country:US
Practice Address - Phone:706-313-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT002135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist