Provider Demographics
NPI:1043833643
Name:CUNNINGHAM, RALPH (MA,LLPC,ADA)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MA,LLPC,ADA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20101
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49019-1101
Mailing Address - Country:US
Mailing Address - Phone:269-389-9670
Mailing Address - Fax:
Practice Address - Street 1:16057 BLUE STAR M HWY
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9470
Practice Address - Country:US
Practice Address - Phone:269-389-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007689101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)