Provider Demographics
NPI:1700587565
Name:CYTIQUE DAVIS PHD LLC
Entity type:Organization
Organization Name:CYTIQUE DAVIS PHD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYTIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFTA
Authorized Official - Phone:256-321-6112
Mailing Address - Street 1:1428 WEATHERLY RD SE STE 102
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1181
Mailing Address - Country:US
Mailing Address - Phone:256-321-6112
Mailing Address - Fax:
Practice Address - Street 1:2225 DRAKE AVE SW STE 15
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5189
Practice Address - Country:US
Practice Address - Phone:256-321-6112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty