Healthcare Provider Details

I. General information

NPI: 1356592869
Provider Name (Legal Business Name): LAURIE A CUNNINGHAM MED, PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 S RIVERSIDE DR
MCCONNELSVILLE OH
43756-0506
US

IV. Provider business mailing address

2845 BELL ST
ZANESVILLE OH
43701-1720
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-9766
  • Fax: 740-588-6452
Mailing address:
  • Phone: 740-454-9766
  • Fax: 740-588-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC0602138
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0602138
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0602138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: