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General NPI Number Information
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NPI Number | 1316293756
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Entity Type | Individual
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Provider Name | REGINALD CUNNINGHAM
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Gender | Male
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 939 SAINT PAUL ST UNIT 3
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City | BALTIMORE
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State | MD
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Zip | 21202-2560
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Country | US
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Telephone | 410-961-7192
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Fax | 301-386-1046
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Provider Business Mailing Address
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Address Line | 635 PALMERTON TER
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City | LANDOVER
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State | MD
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Zip | 20785-5901
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Country | US
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Telephone | 410-961-7192
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Fax | 301-386-1046
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC4114
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License Number State | MD
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