Provider Demographics
NPI:1912941139
Name:CECIL, ARDIS G (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARDIS
Middle Name:G
Last Name:CECIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-3638
Mailing Address - Country:US
Mailing Address - Phone:334-365-7657
Mailing Address - Fax:
Practice Address - Street 1:LIFE SKILLS CLINIC
Practice Address - Street 2:42D ABW MEDICAL GROUP
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-5055
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2269103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist