Provider Demographics
NPI:1831287028
Name:DAVIS, CYNTHIA C (PHD,CHT)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2527 S 11TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4747
Mailing Address - Country:US
Mailing Address - Phone:269-683-3299
Mailing Address - Fax:269-683-3299
Practice Address - Street 1:2527 S 11TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4747
Practice Address - Country:US
Practice Address - Phone:269-683-3299
Practice Address - Fax:269-683-3299
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACHT 696-272101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor