Provider Demographics
NPI:1821204561
Name:CUMMINS, CHARLES CAREY (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CAREY
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CHAFFIN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2317
Mailing Address - Country:US
Mailing Address - Phone:770-594-8599
Mailing Address - Fax:
Practice Address - Street 1:360 CHAFFIN RIDGE CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2317
Practice Address - Country:US
Practice Address - Phone:770-594-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003435101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor