Provider Demographics
NPI:1003460395
Name:CUNNINGHAM, MARQUITA MELISSA
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:MELISSA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WICHERS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3054
Mailing Address - Country:US
Mailing Address - Phone:504-383-7448
Mailing Address - Fax:504-383-7448
Practice Address - Street 1:1003 HUGH WALLIS RD S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2528
Practice Address - Country:US
Practice Address - Phone:337-205-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator