Provider Demographics
NPI:1164894176
Name:RUMAGE, DIANA (LCADC, LPCC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RUMAGE
Suffix:
Gender:F
Credentials:LCADC, LPCC
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 1429
Mailing Address - Street 2:300 HOPE STREET
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-1429
Mailing Address - Country:US
Mailing Address - Phone:800-456-1386
Mailing Address - Fax:502-538-1100
Practice Address - Street 1:1925 FREDERICA ST STE 200
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-926-2484
Practice Address - Fax:270-685-6015
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242652101YM0800X
KY164221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100556250Medicaid