Healthcare Provider Details

I. General information

NPI: 1689306755
Provider Name (Legal Business Name): GILLIAN ROSE CUNNISON MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 EL CAMINO REAL STE 101
CARLSBAD CA
92008-8816
US

IV. Provider business mailing address

5000 WHITE OAK RD
CHARLOTTE NC
28210-2327
US

V. Phone/Fax

Practice location:
  • Phone: 760-539-5818
  • Fax:
Mailing address:
  • Phone: 917-698-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: