Provider Demographics
NPI:1295064848
Name:CUNNINGHAM, ANNE R (MC, LPC, LISAC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:R
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MC, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86339-0514
Mailing Address - Country:US
Mailing Address - Phone:928-300-5752
Mailing Address - Fax:
Practice Address - Street 1:1016 W UNIVERSITY AVE
Practice Address - Street 2:STE 202
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2994
Practice Address - Country:US
Practice Address - Phone:928-774-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10243101YA0400X
AZLPC2514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)