Provider Demographics
NPI:1942413307
Name:CUNNINGHAM, VALARIE S (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:VALARIE
Middle Name:S
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9158
Mailing Address - Country:US
Mailing Address - Phone:269-544-0373
Mailing Address - Fax:269-323-4183
Practice Address - Street 1:5805 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1118
Practice Address - Country:US
Practice Address - Phone:269-323-4180
Practice Address - Fax:269-323-4183
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health