Healthcare Provider Details

I. General information

NPI: 1093146961
Provider Name (Legal Business Name): CYNTHIA EADES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 FRANKLIN AVE SW
DECATUR AL
35603-1016
US

IV. Provider business mailing address

2007 FRANKLIN AVE SW
DECATUR AL
35603-1016
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-8351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2894
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: