MEDICARE: BRIAN 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	101YP2500X	Professional Counselor	LPC014629	GA

General Provider Information

NPI Number	:	1558116277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN CUNNINGHAM LPC

Provider Business Mailing Address
First Line	:	5579 CHAMBLEE DUNWOODY RD STE B
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4100
Country	:	US
Telephone Number	:	678-478-8812
Fax Number	:

Provider Business Practice Location Address
First Line	:	5579 CHAMBLEE DUNWOODY RD STE B
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4100
Country	:	US
Telephone Number	:	678-478-8812
Fax Number	:

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

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	06/27/2024

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