Provider Demographics
NPI:1710947536
Name:CUNNINGHAM, KELLY BETH (LPCMH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BETH
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 CONCORD PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3642
Mailing Address - Country:US
Mailing Address - Phone:302-428-0205
Mailing Address - Fax:
Practice Address - Street 1:1521 CONCORD PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3642
Practice Address - Country:US
Practice Address - Phone:302-428-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000738101YP2500X
KS700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
2193730OtherCIGNA BEHAVIORAL HEALTH