Active NPI
Cynthia Dianne Roberts, LMHC
- Mental Health Counselor
- Palm Coast, FL
National Provider Identifier
1437276912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH12217
- Practice address
- 160 Cypress Point Pkwy
Palm Coast, FL 32164-8433 - Phone
- (386) 585-4645
- Fax
- (386) 276-3474
- NPI assigned
- Mar 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH12217 | FL | Primary |
| Mental Health Counselor | 101YM0800X | C8241 | OR |
Addresses
Primary practice location
160 Cypress Point Pkwy
Palm Coast, FL 32164-8433
Mailing address
285 Summit View Ave SE
Salem, OR 97306-8609
Phone (386) 451-0684
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MH12217 | Other | FL | STATE LICENSE |
| C8241 | Other | OR | LICENSE |
Other names 1
- Cynthia Dianne Hairston
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
Phone (786) 244-7711
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH12217 | FL | MD | Mental Health Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1437276912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "285 SUMMIT VIEW AVE SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973068609",
"telephone_number": "386-451-0684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 CYPRESS POINT PKWY",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321648433",
"telephone_number": "386-585-4645",
"fax_number": "386-276-3474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "CYNTHIA",
"middle_name": "DIANNE",
"name_prefix": "Mrs.",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2024-07-30",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH12217",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "C8241",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "MH12217",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "C8241",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CYNTHIA",
"last_name": "HAIRSTON",
"middle_name": "DIANNE",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Palm Coast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.