Cynthia Adeniyi, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC007860 Issued in GA

Practice address

216 N McDonough St
Jonesboro, GA 30236-3608

Phone

(470) 765-6689

NPI assigned

Apr 3, 2007

Last updated

Aug 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cynthia Buster Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 4, 2024 through Mar 4, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Out of the Woods LLC

  • Community/Behavioral Health Agency
  • Jonesboro, GA
  • NPI 1700329646
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1053432096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 N MCDONOUGH ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363608",
            "telephone_number": "571-447-2539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N MCDONOUGH ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363608",
            "telephone_number": "470-765-6689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADENIYI",
        "first_name": "CYNTHIA",
        "name_prefix": "Dr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC007860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58956180",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "BUSTER",
            "credential": "LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.