Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TP2701X | Group Psychotherapist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1164785119 |
---|---|
Provider Name | Dr. Charles John Cunning |
First Address | Gaffney, SC 29340-2853 |
Second Address | Gaffney, SC 29340-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2012 |
Last Update Date | 23/06/2012 |