Provider Demographics
NPI:1265776264
Name:CECIL, DAVID P (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:CECIL
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 CORBITT DR
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1065
Mailing Address - Country:US
Mailing Address - Phone:859-312-8231
Mailing Address - Fax:855-262-3152
Practice Address - Street 1:836 EUCLID AVE STE 314
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1973
Practice Address - Country:US
Practice Address - Phone:859-312-8231
Practice Address - Fax:855-262-3152
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical