Healthcare Provider Details

I. General information

NPI: 1568979888
Provider Name (Legal Business Name): ALICIA NICOLE CUNNINGHAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 WOODSON RD STE 120C
SAINT LOUIS MO
63134-3713
US

IV. Provider business mailing address

4433 WOODSON RD STE 120C
SAINT LOUIS MO
63134-3713
US

V. Phone/Fax

Practice location:
  • Phone: 314-261-3044
  • Fax: 888-501-0347
Mailing address:
  • Phone: 314-261-3044
  • Fax: 888-501-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017041097
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: