Provider Demographics
NPI:1629102884
Name:CUNNINGHAM, MICHAEL D (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N 3RD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2709
Mailing Address - Country:US
Mailing Address - Phone:509-941-8540
Mailing Address - Fax:
Practice Address - Street 1:17 N 3RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2709
Practice Address - Country:US
Practice Address - Phone:509-941-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003291101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)