Provider Demographics
NPI:1437897618
Name:SHIELDS CUNNINGHAM, CHRISTIAN (LMSW, CFSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:SHIELDS CUNNINGHAM
Suffix:
Gender:F
Credentials:LMSW, CFSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 BIG BEND BLVD STE 101&109
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2709
Mailing Address - Country:US
Mailing Address - Phone:314-458-7915
Mailing Address - Fax:
Practice Address - Street 1:8045 BIG BEND BLVD STE 101&109
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2709
Practice Address - Country:US
Practice Address - Phone:314-800-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022007612104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical