Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1194339218 |
---|---|
Provider Name | Jamal Ali Cunningham |
First Address | Las Vegas, NV 89102-2329 |
Second Address | Las Vegas, NV 89102-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2020 |
Last Update Date | 04/09/2020 |