Provider Demographics
NPI:1366015141
Name:SHANKLIN, CYNTHIA SULLIVAN (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SULLIVAN
Last Name:SHANKLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 OLD MADISON PIKE NW STE 620
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4524
Mailing Address - Country:US
Mailing Address - Phone:256-585-5705
Mailing Address - Fax:256-895-3213
Practice Address - Street 1:6767 OLD MADISON PIKE NW STE 620
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4524
Practice Address - Country:US
Practice Address - Phone:256-585-5705
Practice Address - Fax:256-895-3213
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2750101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2750OtherLPC