Provider Demographics
NPI:1821615832
Name:GONZALEZ, CYNTHIA MACHELLE (CADC II, QMHA-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MACHELLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CADC II, QMHA-C
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:MACHELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-0503
Mailing Address - Country:US
Mailing Address - Phone:503-440-8687
Mailing Address - Fax:
Practice Address - Street 1:925 AVENUE S UNIT 1
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7780
Practice Address - Country:US
Practice Address - Phone:503-440-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1-QMHA-1-00261101YM0800X
17-P-11101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health