Provider Demographics
NPI:1184149643
Name:LUMPKIN, SUNNIE LEIGH (LISW)
Entity type:Individual
Prefix:MRS
First Name:SUNNIE
Middle Name:LEIGH
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 REILY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2623
Mailing Address - Country:US
Mailing Address - Phone:513-407-1190
Mailing Address - Fax:
Practice Address - Street 1:415 REILY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2623
Practice Address - Country:US
Practice Address - Phone:513-407-1190
Practice Address - Fax:513-672-1007
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1200504104100000X
OHI.20022271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.2002227OtherBOARD CERTIFICATION FOR INDEPENDENT LICENSURE