Provider Demographics
NPI:1912204173
Name:DAVIS, CYNTHIA D (LPC, CACIII)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1127
Mailing Address - Country:US
Mailing Address - Phone:303-388-8191
Mailing Address - Fax:303-355-0899
Practice Address - Street 1:2121 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1127
Practice Address - Country:US
Practice Address - Phone:303-388-8191
Practice Address - Fax:303-355-0899
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3585101YA0400X
CO1989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional