Provider Demographics
NPI:1093106114
Name:CUNNINGHAM-ELIOUS, DENISE JOY (MA, LPC, CAADC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:JOY
Last Name:CUNNINGHAM-ELIOUS
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 MAIN ST W
Mailing Address - Street 2:SUITE 20 B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3164
Mailing Address - Country:US
Mailing Address - Phone:678-344-7836
Mailing Address - Fax:678-892-8575
Practice Address - Street 1:2795 MAIN ST W
Practice Address - Street 2:SUITE 20 B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3164
Practice Address - Country:US
Practice Address - Phone:678-344-7836
Practice Address - Fax:678-892-8575
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional