| Doctor Name: | MRS. CHANNON M CUNNINGHAM |
| NPI Number: | 1023096856 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW, CAC/CCDP |
| License Number: | |
| Business Practice Address: | 460 Market St Suite 223 Williamsport, PA - 177016385 |
| Business Phone Number: | 5706519190 |
| Business Fax Number: | 5706519250 |
| Mailing Address: | 460 Market St, Suite 223 WILLIAMSPORT |
| State: | PA |
| Postal Code: | 177016385 |
| Phone Number: | 5706519190 |
| Fax Number: | 5706519250 |
| NPI Enumeration Date: | 01/03/2006 |
| NPI Last Update Date: | 09/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |