Provider Demographics
NPI:1215333497
Name:CUNNINGHAM, PATSY (MA, LCPC)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1855
Mailing Address - Country:US
Mailing Address - Phone:443-824-3612
Mailing Address - Fax:
Practice Address - Street 1:3659 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1855
Practice Address - Country:US
Practice Address - Phone:443-824-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health