Provider Demographics
NPI:1023696234
Name:HUMMEL, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 LAKESIDE DR UNIT 306
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-3145
Mailing Address - Country:US
Mailing Address - Phone:304-476-8395
Mailing Address - Fax:
Practice Address - Street 1:1933 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1008
Practice Address - Country:US
Practice Address - Phone:434-616-6762
Practice Address - Fax:434-616-6766
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704009027101YM0800X
VA0701010419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health