Provider Demographics
NPI:1821002791
Name:BOCKWITZ, CYNTHIA LEE (LPC, CPCS, RPT-S)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LEE
Last Name:BOCKWITZ
Suffix:
Gender:F
Credentials:LPC, CPCS, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TUXWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5620
Mailing Address - Country:US
Mailing Address - Phone:404-702-2007
Mailing Address - Fax:413-513-9503
Practice Address - Street 1:558 MEDLOCK RD
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1512
Practice Address - Country:US
Practice Address - Phone:404-702-2007
Practice Address - Fax:413-513-9503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health