Healthcare Provider Details

I. General information

NPI: 1679682736
Provider Name (Legal Business Name): CYNTHIA L DAUGHERTY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 13TH ST NW
CANTON OH
44708-3116
US

IV. Provider business mailing address

832 MCKINLEY AVE NW
CANTON OH
44703-2463
US

V. Phone/Fax

Practice location:
  • Phone: 330-588-2240
  • Fax: 330-454-4357
Mailing address:
  • Phone: 330-452-9812
  • Fax: 330-430-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE4176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: