Provider Demographics
NPI:1316776164
Name:CUNNINGHAM, DAVID THOMAS (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CINDY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-3713
Mailing Address - Country:US
Mailing Address - Phone:931-743-8080
Mailing Address - Fax:
Practice Address - Street 1:1440 CINDY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ESTILL SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37330-3713
Practice Address - Country:US
Practice Address - Phone:931-580-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health