Provider Demographics
NPI:1457402117
Name:CHAMPION, CYNTHIA A (LMFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 SAINT LUKES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7108
Mailing Address - Country:US
Mailing Address - Phone:334-244-0702
Mailing Address - Fax:334-277-2786
Practice Address - Street 1:386 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7108
Practice Address - Country:US
Practice Address - Phone:334-244-0702
Practice Address - Fax:334-277-2786
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist