Individual
MRS. CHANNON M CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, CAC/CCDP
Contact information
Practice address
460 MARKET ST, STE 114, WILLIAMSPORT, PA 17701-6321
(570) 212-9481
Mailing address
460 MARKET ST, STE 114, WILLIAMSPORT, PA 17701-6321
(570) 212-9481
(570) 651-9250
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
CW014860
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1362328
BLUE CROSS/BLUE SHIELD
PA
Enumeration date
01/03/2006
Last updated
10/27/2020
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