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General NPI Number Information
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NPI Number | 1912434440
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Entity Type | Individual
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Provider Name | DR. NASTASSJIAH CUNNINGHAM
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Gender | Female
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 05/15/2017
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Provider Practice Location Address
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Address Line | 310 ROSS RD APT 14G
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City | COLUMBIA
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State | SC
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Zip | 29223-4913
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Country | US
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Telephone | 910-574-1191
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 212416
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City | COLUMBIA
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State | SC
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Zip | 29221-2416
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Country | US
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Telephone | 864-341-1781
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9863
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License Number State | SC
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