Provider Demographics
NPI:1396493268
Name:CHRISTIAN, CYNTHIA RIVERLY (LCDC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RIVERLY
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NASA PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3325
Mailing Address - Country:US
Mailing Address - Phone:832-240-4745
Mailing Address - Fax:
Practice Address - Street 1:16100 SPACE CENTER BLVD APT 514
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-6231
Practice Address - Country:US
Practice Address - Phone:979-313-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15456101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)