Healthcare Provider Details

I. General information

NPI: 1801305834
Provider Name (Legal Business Name): JACQUELINE CUNNINGHAM MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE OWENS

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 ARCADIA DR
FREDERICK MD
21703-7662
US

IV. Provider business mailing address

4714 ARCADIA DR STE 100-125
FREDERICK MD
21703-7662
US

V. Phone/Fax

Practice location:
  • Phone: 855-935-3691
  • Fax:
Mailing address:
  • Phone: 703-508-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000988
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: