Provider Demographics
NPI:1104096221
Name:SHAPUITE, CINDY M (LPCCS)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:M
Last Name:SHAPUITE
Suffix:
Gender:F
Credentials:LPCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 ROCKWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1421
Mailing Address - Country:US
Mailing Address - Phone:330-806-0566
Mailing Address - Fax:
Practice Address - Street 1:1113 ROCKWOOD AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1421
Practice Address - Country:US
Practice Address - Phone:330-806-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006470101YP2500X
OHE0002886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12451Medicaid