Provider Demographics
NPI:1447341235
Name:GRACE, CYNTHIA G (MS, LCMHC, LADC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:G
Last Name:GRACE
Suffix:
Gender:F
Credentials:MS, LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 FAIRFIELD ST
Mailing Address - Street 2:C/O CDAS
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1743
Mailing Address - Country:US
Mailing Address - Phone:802-524-7265
Mailing Address - Fax:802-524-5723
Practice Address - Street 1:172 FAIRFIELD ST
Practice Address - Street 2:C/O CDAS
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1743
Practice Address - Country:US
Practice Address - Phone:802-524-7265
Practice Address - Fax:802-524-5723
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000360101YA0400X
VT068-0000605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health