Individual
MR. GRADY EUGENE CUNNINGHAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
680 NORTHLAND BLVD, CINCINNATI, OH 45240-3248
(513) 941-4999
(513) 648-9859
Mailing address
680 NORTHLAND BLVD, CINCINNATI, OH 45240-3248
(513) 941-4999
(513) 648-9859
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
.165808
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063000
—
OH
05
—
287
—
OH
Enumeration date
03/27/2018
Last updated
03/27/2018
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