Provider Demographics
NPI:1801344270
Name:CUNNINGHAM, KENNETH GAITHER SR (MA,CAC-AD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GAITHER
Last Name:CUNNINGHAM
Suffix:SR
Gender:M
Credentials:MA,CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BRIGHTSEAT RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4725
Mailing Address - Country:US
Mailing Address - Phone:301-909-2436
Mailing Address - Fax:301-909-2301
Practice Address - Street 1:925 BRIGHTSEAT RD
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4725
Practice Address - Country:US
Practice Address - Phone:301-909-2436
Practice Address - Fax:301-909-2301
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0575101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)