Doctor Name: | JENNY SUE CUNNINGHAM |
NPI Number: | 1295894459 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCMHC |
License Number: | 068-0000465 |
Business Practice Address: | 20 W Canal St Suite C2 Winooski, VT - 054042131 |
Business Phone Number: | 8026547600 |
Business Fax Number: | 8026547601 |
Mailing Address: | 20 W Canal St, Suite C2 WINOOSKI |
State: | VT |
Postal Code: | 054042131 |
Phone Number: | 8026547600 |
Fax Number: | 8026547601 |
NPI Enumeration Date: | 12/06/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 068-0000465 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |