Provider Demographics
NPI:1073687737
Name:CUNNINGHAM, MAUREEN MALA (PHD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:MALA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MALA
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1924 ARLINGTON BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-1533
Mailing Address - Country:US
Mailing Address - Phone:434-296-7100
Mailing Address - Fax:
Practice Address - Street 1:1924 ARLINGTON BLVD STE 207
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1533
Practice Address - Country:US
Practice Address - Phone:434-296-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001629103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling