Provider Demographics
NPI:1073965349
Name:BROWN CUNNINGHAM, SAMANTHA KARLENE (PHD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KARLENE
Last Name:BROWN CUNNINGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KARLENE
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2056
Practice Address - Country:US
Practice Address - Phone:252-744-1406
Practice Address - Fax:252-744-2419
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01570103TC0700X
NC5007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical