Provider Demographics
NPI:1275198244
Name:DAVANI, CYRUS (LCPC)
Entity Type:Individual
Prefix:
First Name:CYRUS
Middle Name:
Last Name:DAVANI
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 DARNESTOWN RD
Mailing Address - Street 2:STE 205
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-714-8120
Mailing Address - Fax:240-623-8120
Practice Address - Street 1:10810 DARNESTOWN RD
Practice Address - Street 2:STE 205
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-714-8120
Practice Address - Fax:240-623-8120
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9328101YP2500X
MDLC9328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional