Healthcare Provider Details

I. General information

NPI: 1861956799
Provider Name (Legal Business Name): CYNTHIA D. RUDICK, PH.D, LPCC-S & CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 HIGBEE AVE NW STE 6B
CANTON OH
44718-2551
US

IV. Provider business mailing address

4765 HIGBEE AVE NW STE 6B
CANTON OH
44718-2551
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-2266
  • Fax:
Mailing address:
  • Phone: 330-492-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA D RUDICK
Title or Position: OWNER
Credential: PH.D, LPCC-S
Phone: 330-492-2266