Provider Demographics
NPI:1669094553
Name:CUNNINGHAM, CAPRICIA ROCHELLE
Entity type:Individual
Prefix:
First Name:CAPRICIA
Middle Name:ROCHELLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 BLAIR RD APT A
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3214
Mailing Address - Country:US
Mailing Address - Phone:907-538-2154
Mailing Address - Fax:
Practice Address - Street 1:998 BLAIR RD APT A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3214
Practice Address - Country:US
Practice Address - Phone:907-538-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty