Provider Demographics
NPI:1073777850
Name:CUMMINGS, PAT L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAT
Middle Name:L
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:803 E WALKER STREET
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2434 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6942
Practice Address - Country:US
Practice Address - Phone:662-844-1717
Practice Address - Fax:662-680-5129
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC75171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018203Medicaid