Provider Demographics
NPI:1134473424
Name:WADYSZ, CYNTHIA (LPC, PC, CHT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WADYSZ
Suffix:
Gender:F
Credentials:LPC, PC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14765 IDA WEST RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9506
Mailing Address - Country:US
Mailing Address - Phone:734-625-0011
Mailing Address - Fax:
Practice Address - Street 1:5758 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1990
Practice Address - Country:US
Practice Address - Phone:734-625-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100230101Y00000X
MI6401013381101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor