Provider Demographics
NPI:1104247915
Name:CUMMINGS, KARLIN-RAE MACKENZIE (MS)
Entity type:Individual
Prefix:MRS
First Name:KARLIN-RAE
Middle Name:MACKENZIE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KARLIN-RAE
Other - Middle Name:MACKENZIE
Other - Last Name:MATTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:431 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3187
Mailing Address - Country:US
Mailing Address - Phone:803-278-0880
Mailing Address - Fax:
Practice Address - Street 1:431 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3187
Practice Address - Country:US
Practice Address - Phone:803-278-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health