Healthcare Provider Details

I. General information

NPI: 1073687737
Provider Name (Legal Business Name): MAUREEN MALA CUNNINGHAM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALA CUNNINGHAM PH.D.

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ARLINGTON BLVD STE 207
CHARLOTTESVILLE VA
22903-1533
US

IV. Provider business mailing address

1924 ARLINGTON BLVD STE 207
CHARLOTTESVILLE VA
22903-1533
US

V. Phone/Fax

Practice location:
  • Phone: 434-296-7100
  • Fax:
Mailing address:
  • Phone: 434-296-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0701001629
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: