Provider Demographics
NPI:1770875544
Name:CUMMINS, MICHELE (MA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ROSE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 E MORSE BLVD
Mailing Address - Street 2:APT. 2-33
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3884
Mailing Address - Country:US
Mailing Address - Phone:407-949-2228
Mailing Address - Fax:
Practice Address - Street 1:21 COLUMBIA ST STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1133
Practice Address - Country:US
Practice Address - Phone:407-262-2220
Practice Address - Fax:407-834-5011
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH11907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health