Provider Demographics
NPI:1578054318
Name:CUNNINGHAM-DOGGETT, DENISE RENEE (MDIV, BA, CDCA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:CUNNINGHAM-DOGGETT
Suffix:
Gender:F
Credentials:MDIV, BA, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 RAYMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2617
Mailing Address - Country:US
Mailing Address - Phone:216-321-3761
Mailing Address - Fax:
Practice Address - Street 1:4600 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4371
Practice Address - Country:US
Practice Address - Phone:216-321-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)