Provider Demographics
NPI:1184459471
Name:CUNNINGHAM, VIRGINIA (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 OAK CREST CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4186
Mailing Address - Country:US
Mailing Address - Phone:770-579-3863
Mailing Address - Fax:
Practice Address - Street 1:2450 OLD MILTON PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2521
Practice Address - Country:US
Practice Address - Phone:470-267-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical