Provider Demographics
NPI:1851178438
Name:CUMMINGS, CRISTINA M (MS, LAC)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:M
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12822 N 78TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5282
Mailing Address - Country:US
Mailing Address - Phone:623-221-9785
Mailing Address - Fax:
Practice Address - Street 1:21448 N 75TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5978
Practice Address - Country:US
Practice Address - Phone:623-221-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20287101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty