=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851402416
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA J DAVIS MSW, LGSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 03/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 PERRY HILL RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36109-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-272-4670
-----------------------------------------------------
Fax | 334-725-2986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 E SARNIA ST STE 2100
-----------------------------------------------------
City | WINONA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55987-6414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-454-4341
-----------------------------------------------------
Fax | 507-453-6267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 31627
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 1090G
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------