Provider Demographics
NPI:1154452704
Name:CUNNINGHAM, MARY CAMILLE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAMILLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 EL SOLINDO AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4049
Mailing Address - Country:US
Mailing Address - Phone:505-822-1323
Mailing Address - Fax:
Practice Address - Street 1:11820 EL SOLINDO AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4049
Practice Address - Country:US
Practice Address - Phone:505-822-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health