Provider Demographics
NPI:1043406556
Name:CUNNINGHAM, JANEY
Entity Type:Individual
Prefix:MISS
First Name:JANEY
Middle Name:
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 1:3952 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-7613
Mailing Address - Country:US
Mailing Address - Phone:240-274-1269
Mailing Address - Fax:
Practice Address - Street 1:1063 DETROIT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2411
Practice Address - Country:US
Practice Address - Phone:925-685-2941
Practice Address - Fax:925-685-2958
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist