Provider Demographics
NPI:1699069864
Name:CUNNINGHAM, JENNIFER (MS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SPANHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 W DIAMOND AVE
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2187
Mailing Address - Country:US
Mailing Address - Phone:301-963-6392
Mailing Address - Fax:
Practice Address - Street 1:23 W DIAMOND AVE
Practice Address - Street 2:SUITE 200 A
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2187
Practice Address - Country:US
Practice Address - Phone:301-963-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM364101YP1600X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral