Provider Demographics
NPI:1801870068
Name:CUNNINGHAM, DARRICK DEWAYNE (MSW)
Entity type:Individual
Prefix:MR
First Name:DARRICK
Middle Name:DEWAYNE
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2667 BLOOMSBERRY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7292
Mailing Address - Country:US
Mailing Address - Phone:919-567-2270
Mailing Address - Fax:
Practice Address - Street 1:51 MDOS/SGOH
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96266
Practice Address - Country:KR
Practice Address - Phone:315-784-2149
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0578081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical