Provider Demographics
NPI:1245880871
Name:CUNNINGHAM, ALONZO
Entity type:Individual
Prefix:
First Name:ALONZO
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ALONZO
Other - Middle Name:R
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3512 SW EVENINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-3834
Mailing Address - Country:US
Mailing Address - Phone:904-240-8578
Mailing Address - Fax:
Practice Address - Street 1:1515 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1304
Practice Address - Country:US
Practice Address - Phone:904-240-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty