Provider Demographics
NPI:1922023621
Name:LUMPKIN, L D (LCSW LISAC)
Entity Type:Individual
Prefix:
First Name:L D
Middle Name:
Last Name:LUMPKIN
Suffix:
Gender:M
Credentials:LCSW LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 MESQUITE AVE
Mailing Address - Street 2:STE 216
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5688
Mailing Address - Country:US
Mailing Address - Phone:928-453-0404
Mailing Address - Fax:928-855-2778
Practice Address - Street 1:1695 MESQUITE AVE
Practice Address - Street 2:STE 216
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5688
Practice Address - Country:US
Practice Address - Phone:928-453-0404
Practice Address - Fax:928-855-2778
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11050101YA0400X
AZ4026LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z83642Medicare ID - Type Unspecified