Healthcare Provider Details

I. General information

NPI: 1548099716
Provider Name (Legal Business Name): CYNTHIA DAVIS DUPREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 APPALACHIAN CT
CHESAPEAKE VA
23320-1623
US

IV. Provider business mailing address

PO BOX 1952
CHESAPEAKE VA
23327-1952
US

V. Phone/Fax

Practice location:
  • Phone: 757-790-7906
  • Fax:
Mailing address:
  • Phone: 757-790-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA DUPREE
Title or Position: COUNSELOR
Credential: SAP M ED ICAADC LCAS
Phone: 757-790-7906