Provider Demographics
NPI:1184640807
Name:HUMMELL, JAMIE LYNN (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:HUMMELL
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FIELDSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3118
Mailing Address - Country:US
Mailing Address - Phone:302-598-4545
Mailing Address - Fax:302-733-0701
Practice Address - Street 1:226 W PARK PL
Practice Address - Street 2:SUITE 6
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4565
Practice Address - Country:US
Practice Address - Phone:302-733-0700
Practice Address - Fax:302-733-0701
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036045Medicaid