Provider Demographics
NPI:1629808316
Name:CUNNINGHAM, JESSICA (MACP, LHMCA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MACP, LHMCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 218TH ST SW APT 42
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7947
Mailing Address - Country:US
Mailing Address - Phone:281-796-1260
Mailing Address - Fax:
Practice Address - Street 1:3524 NE 95TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2553
Practice Address - Country:US
Practice Address - Phone:206-486-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61531560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health