Provider Demographics
NPI:1669643268
Name:CUNNINGHAM & JORDAN COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:CUNNINGHAM & JORDAN COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-331-2010
Mailing Address - Street 1:20939 LORAIN RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2022
Mailing Address - Country:US
Mailing Address - Phone:440-331-2010
Mailing Address - Fax:440-331-2052
Practice Address - Street 1:20939 LORAIN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2022
Practice Address - Country:US
Practice Address - Phone:440-331-2010
Practice Address - Fax:440-331-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-22
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00095621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty