Provider Demographics
NPI:1073138152
Name:CUNNINGHAM, LESLIE (ALC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 NOCOSEKA TRL APT B4
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6720
Mailing Address - Country:US
Mailing Address - Phone:256-689-5593
Mailing Address - Fax:
Practice Address - Street 1:1436 NOCOSEKA TRL APT B4
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6720
Practice Address - Country:US
Practice Address - Phone:256-689-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3399101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor