Healthcare Provider Details

I. General information

NPI: 1639210248
Provider Name (Legal Business Name): CYNTHIA DIANE ZILLS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 MAIN ST
DAPHNE AL
36526-8623
US

IV. Provider business mailing address

127 MELANIE LOOP
DAPHNE AL
36526-8021
US

V. Phone/Fax

Practice location:
  • Phone: 931-242-6514
  • Fax:
Mailing address:
  • Phone: 931-242-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6858C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: