Provider Demographics
NPI:1316293756
Name:CUNNINGHAM, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 PALMERTON TER
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5901
Mailing Address - Country:US
Mailing Address - Phone:410-961-7192
Mailing Address - Fax:301-386-1046
Practice Address - Street 1:939 SAINT PAUL ST
Practice Address - Street 2:UNIT 3
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2560
Practice Address - Country:US
Practice Address - Phone:410-961-7192
Practice Address - Fax:301-386-1046
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4114101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional