Provider Demographics
NPI:1841757630
Name:CUMINGS, SUSAN E (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:CUMINGS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2811 W MORRELL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2643
Mailing Address - Country:US
Mailing Address - Phone:860-870-8787
Mailing Address - Fax:
Practice Address - Street 1:2811 W MORRELL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2643
Practice Address - Country:US
Practice Address - Phone:860-870-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MI6401016253101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional