Provider Demographics
NPI:1720527690
Name:CUMMINGS, KATHLEEN (CAC III)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3310
Mailing Address - Country:US
Mailing Address - Phone:303-431-5664
Mailing Address - Fax:303-431-6713
Practice Address - Street 1:4485 WADSWORTH BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3310
Practice Address - Country:US
Practice Address - Phone:303-431-5664
Practice Address - Fax:303-431-6713
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC 0006456101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACC 0006456OtherCAC LICENSE