Provider Demographics
NPI:1700239480
Name:CUNNINGHAM, JULIE (LCSW,LCDC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LCSW,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LOVETT BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-3908
Mailing Address - Country:US
Mailing Address - Phone:713-377-4190
Mailing Address - Fax:561-570-1266
Practice Address - Street 1:900 LOVETT BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3908
Practice Address - Country:US
Practice Address - Phone:713-377-4190
Practice Address - Fax:561-570-1266
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX561751041C0700X
TX3621101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty