Provider Demographics
NPI:1780673152
Name:CUMBERLAND LIFESPAN CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:CUMBERLAND LIFESPAN CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-433-2344
Mailing Address - Street 1:4994 LOWER ROSWELL RD
Mailing Address - Street 2:SUITE #29
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4332
Mailing Address - Country:US
Mailing Address - Phone:404-433-2344
Mailing Address - Fax:678-236-6041
Practice Address - Street 1:4994 LOWER ROSWELL RD
Practice Address - Street 2:SUITE #29
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4332
Practice Address - Country:US
Practice Address - Phone:404-433-2344
Practice Address - Fax:678-236-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty