Provider Demographics
NPI:1952708158
Name:CUNNINGHAM, ADAM (ED S)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 44TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-1611
Mailing Address - Country:US
Mailing Address - Phone:330-491-3780
Mailing Address - Fax:
Practice Address - Street 1:901 44TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1611
Practice Address - Country:US
Practice Address - Phone:330-491-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3004404103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool