Provider Demographics
NPI:1316974892
Name:CUMMINS, JULIE (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 N. BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1767
Mailing Address - Country:US
Mailing Address - Phone:615-323-0573
Mailing Address - Fax:615-323-0574
Practice Address - Street 1:458 N. BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1767
Practice Address - Country:US
Practice Address - Phone:615-323-0573
Practice Address - Fax:615-323-0574
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3534104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker