Healthcare Provider Details

I. General information

NPI: 1598101610
Provider Name (Legal Business Name): MRS. BARBARA LETICIA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA LETICIA GARCIA

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARRIS SPRINGS RD
LAS VEGAS NV
89124-9215
US

IV. Provider business mailing address

1409 HELEN BELLE DR
LAS VEGAS NV
89110-2806
US

V. Phone/Fax

Practice location:
  • Phone: 702-872-5382
  • Fax: 702-872-5381
Mailing address:
  • Phone: 702-872-5382
  • Fax: 702-872-5381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: