Provider Demographics
NPI:1093555997
Name:MCCUMBER, BRIANNA KAY
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:KAY
Last Name:MCCUMBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FITTING AVE
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-1156
Mailing Address - Country:US
Mailing Address - Phone:614-254-7918
Mailing Address - Fax:
Practice Address - Street 1:8402 BLACKJACK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9193
Practice Address - Country:US
Practice Address - Phone:749-397-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183112101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)