Healthcare Provider Details

I. General information

NPI: 1437458122
Provider Name (Legal Business Name): JOANNE LYNNE CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNE LYNNE STUBBS

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 RICHMOND TAPPAHANOCK HIGHWAY, SUITE 204A
AYLETT VA
23009
US

IV. Provider business mailing address

26947 THE TRAIL
MATTAPONI VA
23110
US

V. Phone/Fax

Practice location:
  • Phone: 804-647-2783
  • Fax:
Mailing address:
  • Phone: 804-647-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: