Provider Demographics
NPI:1750895736
Name:MCGRAW, CINDY LYNN
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:LYNN
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 WHITFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1159
Mailing Address - Country:US
Mailing Address - Phone:248-736-4521
Mailing Address - Fax:248-623-1766
Practice Address - Street 1:3455 WHITFIELD DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-1159
Practice Address - Country:US
Practice Address - Phone:248-736-4521
Practice Address - Fax:248-623-1766
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002855101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVS0091165Medicaid