Provider Demographics
NPI:1366530776
Name:CANTOR, CELIA S (MA)
Entity type:Individual
Prefix:MS
First Name:CELIA
Middle Name:S
Last Name:CANTOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 LIME QUARRY RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8962
Mailing Address - Country:US
Mailing Address - Phone:256-461-8896
Mailing Address - Fax:256-461-8897
Practice Address - Street 1:190 LIME QUARRY RD
Practice Address - Street 2:SUITE 116
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8962
Practice Address - Country:US
Practice Address - Phone:256-461-8896
Practice Address - Fax:256-461-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional