Healthcare Provider Details

I. General information

NPI: 1275854903
Provider Name (Legal Business Name): CYNTHIA DANIELLE CAUSEY M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 MARKS CHURCH RD
AUGUSTA GA
30909-6329
US

IV. Provider business mailing address

1285 MARKS CHURCH RD
AUGUSTA GA
30909-6329
US

V. Phone/Fax

Practice location:
  • Phone: 404-583-6668
  • Fax:
Mailing address:
  • Phone: 404-583-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC005890
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: