MEDICARE: MRS. HOLLY CUNNINGHAM LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	7360	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7360	OTHER	NC	NC BOARD OF LICENSED PROFESSIONAL COUNSELORS

General Provider Information

NPI Number	:	1003059551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY CUNNINGHAM LPC

Provider Business Mailing Address
First Line	:	3963 MARKET ST
Second Line	:	SUITE A
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1403
Country	:	US
Telephone Number	:	910-362-9474
Fax Number	:	910-362-9192

Provider Business Practice Location Address
First Line	:	3963 MARKET ST
Second Line	:	SUITE A
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1403
Country	:	US
Telephone Number	:	910-362-9474
Fax Number	:	910-362-9192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/14/2009

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