Provider Demographics
NPI:1942592167
Name:CUNNINGHAM, GENA A (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:A
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 1:23700 VAN DYKE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1600
Mailing Address - Country:US
Mailing Address - Phone:248-967-4310
Mailing Address - Fax:248-967-4301
Practice Address - Street 1:23700 VAN DYKE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1600
Practice Address - Country:US
Practice Address - Phone:248-967-4310
Practice Address - Fax:248-967-4301
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010671111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical