Individual
MRS. CYNTHIA DEWATERS BALOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC LCADC
Contact information
Practice address
3314 PAPER MILL RD STE 100, PHOENIX, MD 21131-1446
(410) 802-4049
(866) 561-6670
Mailing address
3314 PAPER MILL RD STE 100, PHOENIX, MD 21131-1446
(410) 802-4049
(866) 561-6670
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA362
MD
101YP2500X
Professional Counselor
Primary
LC1289
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
461922374
CIGNA
MD
01
—
62464101
CAREFIRST MD
—
01
—
676829
BEACON HEALTH OPTIONS
MD
05
—
699558600
—
MD
01
—
RS830034
CAREFIRST GHMSI
—
Enumeration date
09/28/2006
Last updated
10/13/2021
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