| NPI | 1609121011 |
|---|---|
| Former Name | SHANNON CUNNINGHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LICSW128334) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2024-08-27 |