Provider Demographics
NPI:1851370076
Name:TICE, CYNTHIA GRIFFIRTH (MA, LPC, NCC, CCAS)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GRIFFIRTH
Last Name:TICE
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 CHAMPAIGN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6323
Mailing Address - Country:US
Mailing Address - Phone:704-365-7777
Mailing Address - Fax:704-365-9256
Practice Address - Street 1:6809 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3336
Practice Address - Country:US
Practice Address - Phone:704-365-7777
Practice Address - Fax:704-365-9256
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health