Individual
GRANT WILLIAM CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
880 82ND DR, GLADSTONE, OR 97027-1803
(503) 659-5515
Mailing address
22550 SW HIGHLAND DR APT 340, SHERWOOD, OR 97140-7041
(720) 988-9565
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19-R-14
OR
Other
Enumeration date
07/19/2019
Last updated
07/19/2019
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