Provider Demographics
NPI:1427707330
Name:CHAMPION, CYNTHIA DENISE (EDUCATOR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DENISE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 GENTIAN BLVD STE 8A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5639
Mailing Address - Country:US
Mailing Address - Phone:912-616-7366
Mailing Address - Fax:470-552-2767
Practice Address - Street 1:3100 GENTIAN BLVD STE 8A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5639
Practice Address - Country:US
Practice Address - Phone:912-616-7366
Practice Address - Fax:470-552-2767
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA869303101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003251476AMedicaid