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General NPI Number Information
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NPI Number | 1992381727
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Entity Type | Individual
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Provider Name | ANNELISE MIYA CUNNINGHAM PHD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 225 E WORTHINGTON AVE
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City | CHARLOTTE
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State | NC
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Zip | 28203-4867
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Country | US
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Telephone | 773-531-8738
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Fax |
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Provider Business Mailing Address
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Address Line | 8013 SWITCHBACK TRL
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City | CHARLOTTE
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State | NC
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Zip | 28213-7165
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0005562
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071010903
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071010903
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0005562
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6750
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License Number State | NC
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