Provider Demographics
NPI:1437458122
Name:CUNNINGHAM, JOANNE LYNNE
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LYNNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LYNNE
Other - Last Name:STUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26947 THE TRAIL
Mailing Address - Street 2:
Mailing Address - City:MATTAPONI
Mailing Address - State:VA
Mailing Address - Zip Code:23110
Mailing Address - Country:US
Mailing Address - Phone:804-647-2783
Mailing Address - Fax:
Practice Address - Street 1:5833 RICHMOND TAPPAHANOCK HIGHWAY, SUITE 204A
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009
Practice Address - Country:US
Practice Address - Phone:804-647-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional