Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0331 | NH |
Y | 101YM0800X | Mental Health Counselor | 237 | NH |
NPI | 1003946112 |
---|---|
Provider Name | Wayne Kieran Cunningham |
First Address | North Conway, NH 03860-0476 |
Second Address | North Conway, NH 03860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 04/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30014439 | (05) | NH |