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General NPI Number Information
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NPI Number | 1801305834
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Entity Type | Individual
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Provider Name | JACQUELINE CUNNINGHAM MA, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 11350 RANDOM HILLS RD STE 240
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City | FAIRFAX
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State | VA
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Zip | 22030-6044
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Country | US
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Telephone | 703-537-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 775 GATEWAY DR SE APT 1228
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City | LEESBURG
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State | VA
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Zip | 20175-4097
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Country | US
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Telephone | 703-508-0387
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133000988
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License Number State | VA
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