Provider Demographics
NPI:1023700226
Name:CUNNINGHAM, SANDRA (LPC, RPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CECELIA CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3262
Mailing Address - Country:US
Mailing Address - Phone:636-362-4138
Mailing Address - Fax:
Practice Address - Street 1:14 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1735
Practice Address - Country:US
Practice Address - Phone:636-362-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017011731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional