Provider Demographics
NPI:1114256229
Name:CUNNINGHAM, BENITA
Entity Type:Individual
Prefix:
First Name:BENITA
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 1:74-381 KEALAKEHE PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2705
Mailing Address - Country:US
Mailing Address - Phone:808-589-1829
Mailing Address - Fax:808-589-2610
Practice Address - Street 1:74-381 KEALAKEHE PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2705
Practice Address - Country:US
Practice Address - Phone:808-589-1829
Practice Address - Fax:808-589-2610
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-35111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical