Provider Demographics
NPI:1588147581
Name:CUNIGAN, CECIL BERNARD (LGPC)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:BERNARD
Last Name:CUNIGAN
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 FARMINGTON LN
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-9457
Mailing Address - Country:US
Mailing Address - Phone:443-621-3021
Mailing Address - Fax:
Practice Address - Street 1:6334 FARMINGTON LN
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-9457
Practice Address - Country:US
Practice Address - Phone:443-621-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional