Provider Demographics
NPI:1609917855
Name:MILLER, CYNTHIA (LICDC-CS)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 BEACHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6415
Mailing Address - Country:US
Mailing Address - Phone:216-581-1662
Mailing Address - Fax:216-581-4540
Practice Address - Street 1:11811 SHAKER BLVD STE 123
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1927
Practice Address - Country:US
Practice Address - Phone:216-242-2990
Practice Address - Fax:216-455-5436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH944079101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty