Provider Demographics
NPI:1881384253
Name:CUNNINGHAM, ANTONETTE THERESA (CDAC)
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:THERESA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:CDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 WHITE FAWN DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4110
Mailing Address - Country:US
Mailing Address - Phone:828-767-5606
Mailing Address - Fax:
Practice Address - Street 1:2 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4104
Practice Address - Country:US
Practice Address - Phone:828-225-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-21364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)