Healthcare Provider Details

I. General information

NPI: 1275610024
Provider Name (Legal Business Name): GLORIA J CUNNINGHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MEDICAL PARK DR
HOPE AR
71801-8100
US

IV. Provider business mailing address

PO BOX 1326
MARSHALL TX
75671-1326
US

V. Phone/Fax

Practice location:
  • Phone: 870-474-5001
  • Fax: 903-791-9353
Mailing address:
  • Phone: 903-927-3782
  • Fax: 903-927-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2416-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: