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General NPI Number Information
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NPI Number | 1003946112
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Entity Type | Individual
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Provider Name | WAYNE KIERAN CUNNINGHAM L.C.M.H.C., L.A.D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 2760 MAIN STREET EASTERN SLOPE INN
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City | NORTH CONWAY
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State | NH
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Zip | 03860
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Country | US
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Telephone | 603-356-9955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 476
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City | NORTH CONWAY
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State | NH
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Zip | 03860-0476
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Country | US
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Telephone | 603-356-9955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0331
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 237
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License Number State | NH
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