Provider Demographics
NPI:1811751399
Name:CUNNINGHAM, THERRIS LAURISE (MSW)
Entity type:Individual
Prefix:
First Name:THERRIS
Middle Name:LAURISE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 ALCATRAZ AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2710
Mailing Address - Country:US
Mailing Address - Phone:510-318-7508
Mailing Address - Fax:510-597-1438
Practice Address - Street 1:1497 ALCATRAZ AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2710
Practice Address - Country:US
Practice Address - Phone:510-318-7508
Practice Address - Fax:510-597-1438
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker