Basic Information
| Provider Information | |||||||||
| NPI: | 1245651595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMMINGS | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCAS, CCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1023 FAIRFIELD CIR | ||||||||
| Address2: | |||||||||
| City: | RAEFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283766607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102237114 | ||||||||
| FaxNumber: | 9106727953 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 STAMPER RD STE G | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283034193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102237114 | ||||||||
| FaxNumber: | 9106727953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2014 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.