Provider Demographics
NPI:1679182059
Name:CUNNINGHAM, CHRISTINE C
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 58TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4808
Mailing Address - Country:US
Mailing Address - Phone:970-495-0444
Mailing Address - Fax:970-224-9624
Practice Address - Street 1:1175 58TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4808
Practice Address - Country:US
Practice Address - Phone:970-495-0444
Practice Address - Fax:970-224-9624
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099261371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical