Provider Demographics
NPI:1033197918
Name:CUMMINGS, JACQUE LUCILLE (LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUE
Middle Name:LUCILLE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 H ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-4019
Mailing Address - Country:US
Mailing Address - Phone:707-954-9541
Mailing Address - Fax:707-464-7845
Practice Address - Street 1:431 H ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4019
Practice Address - Country:US
Practice Address - Phone:707-954-9541
Practice Address - Fax:707-464-7845
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist