| Doctor Name: | DR. CYNTHIA FONG |
| NPI Number: | 1467795500 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | P0308033 |
| Business Practice Address: | 144 Lily Dr Maumelle, AR - 721135826 |
| Business Phone Number: | 5018030166 |
| Business Fax Number: | |
| Mailing Address: | 144 Lily Dr, MAUMELLE |
| State: | AR |
| Postal Code: | 721135826 |
| Phone Number: | 5018030166 |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2013 |
| NPI Last Update Date: | 03/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | P0308033 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |