Healthcare Provider Details

I. General information

NPI: 1801647318
Provider Name (Legal Business Name): CHRISTINA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ARTILLERY PARK DR UNIT 201
FT MITCHELL KY
41017-2798
US

IV. Provider business mailing address

309 ARTILLERY PARK DR UNIT 201
FT MITCHELL KY
41017-2798
US

V. Phone/Fax

Practice location:
  • Phone: 859-488-1126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001636
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: