Provider Demographics
NPI:1538715289
Name:STAVA, CYNTHIA (APCC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:STAVA
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 E CALLE DE RICARDO STE B
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1448
Mailing Address - Country:US
Mailing Address - Phone:760-534-3487
Mailing Address - Fax:760-507-8445
Practice Address - Street 1:4375 E CALLE DE RICARDO STE B
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1448
Practice Address - Country:US
Practice Address - Phone:760-534-3487
Practice Address - Fax:760-507-8445
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional