Provider Demographics
NPI:1164626586
Name:DENHAM, CYNTHIA (LPC, CAAC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DENHAM
Suffix:
Gender:F
Credentials:LPC, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 W PARKWAY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3017
Mailing Address - Country:US
Mailing Address - Phone:248-346-5453
Mailing Address - Fax:313-362-2927
Practice Address - Street 1:12915 W PARKWAY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-3017
Practice Address - Country:US
Practice Address - Phone:248-346-5453
Practice Address - Fax:313-362-2927
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00208101YA0400X
MI6401007066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)