Healthcare Provider Details

I. General information

NPI: 1942413307
Provider Name (Legal Business Name): VALARIE S. CUNNINGHAM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 OAKLAND DR
PORTAGE MI
49024-1118
US

IV. Provider business mailing address

2164 N 10TH ST
KALAMAZOO MI
49009-9158
US

V. Phone/Fax

Practice location:
  • Phone: 269-323-4180
  • Fax: 269-323-4183
Mailing address:
  • Phone: 269-544-0373
  • Fax: 269-323-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801081655
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: