Provider Demographics
NPI:1417251679
Name:CUNNINGHAM, AMANDA ROSE (BA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ROSE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 FLORAL AVE
Mailing Address - Street 2:SUITE #30
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9143
Mailing Address - Country:US
Mailing Address - Phone:530-893-4784
Mailing Address - Fax:
Practice Address - Street 1:2550 FLORAL AVE
Practice Address - Street 2:SUITE #30
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9143
Practice Address - Country:US
Practice Address - Phone:530-893-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health