Provider Demographics
NPI:1588951826
Name:CUMMINGS, DEIRDRE BIANCA (MED LPCA, JD)
Entity type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:BIANCA
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MED LPCA, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DAVENTRY LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3845
Mailing Address - Country:US
Mailing Address - Phone:502-425-7325
Mailing Address - Fax:502-429-7246
Practice Address - Street 1:104 DAVENTRY LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3845
Practice Address - Country:US
Practice Address - Phone:502-425-7325
Practice Address - Fax:502-429-7246
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY102208101Y00000X
KY0654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100284430Medicaid