Provider Demographics
NPI:1851466536
Name:GAULT, CYNTHIA J (LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:J
Last Name:GAULT
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:MS
Other - First Name:CINDY
Other - Middle Name:J
Other - Last Name:GAULT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LMSW, ACSW
Mailing Address - Street 1:2426 ARROWWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1210
Mailing Address - Country:US
Mailing Address - Phone:734-995-0901
Mailing Address - Fax:
Practice Address - Street 1:110 E KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1138
Practice Address - Country:US
Practice Address - Phone:734-995-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010851771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical