Provider Demographics
NPI:1023254950
Name:CUMMINGS FAGAN, DENISE ANN (LMHC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:CUMMINGS FAGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:FAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:14527 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-3102
Mailing Address - Country:US
Mailing Address - Phone:352-521-1474
Mailing Address - Fax:352-521-1477
Practice Address - Street 1:14527 7TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3102
Practice Address - Country:US
Practice Address - Phone:352-521-1474
Practice Address - Fax:352-521-1477
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
FLMH 9645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104546900Medicaid
FL000649000Medicaid