Provider Demographics
NPI:1700165867
Name:FONSECA-SHIVERS, CINDY L (LPC, LCSW)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:FONSECA-SHIVERS
Suffix:
Gender:F
Credentials:LPC, LCSW
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCSW
Mailing Address - Street 1:1794 ALLOUEZ AVE
Mailing Address - Street 2:SUITE C, NUMBER 243
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6281
Mailing Address - Country:US
Mailing Address - Phone:920-367-4025
Mailing Address - Fax:
Practice Address - Street 1:1794 ALLOUEZ AVE
Practice Address - Street 2:SUITE C, NUMBER 243
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6281
Practice Address - Country:US
Practice Address - Phone:920-367-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4233-1231041C0700X, 1041C0700X
WI2359-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical