Provider Demographics
NPI:1679682736
Name:DAUGHERTY, CYNTHIA L (LPCC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 MCKINLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-2463
Mailing Address - Country:US
Mailing Address - Phone:330-452-9812
Mailing Address - Fax:330-430-1288
Practice Address - Street 1:2421 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3116
Practice Address - Country:US
Practice Address - Phone:330-588-2240
Practice Address - Fax:330-454-4357
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional