Healthcare Provider Details

I. General information

NPI: 1164894176
Provider Name (Legal Business Name): DIANA RUMAGE LCADC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 FREDERICA ST STE 200
OWENSBORO KY
42301
US

IV. Provider business mailing address

PO BOX 1429 300 HOPE STREET
MT WASHINGTON KY
40047-1429
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2484
  • Fax: 270-685-6015
Mailing address:
  • Phone: 800-456-1386
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number242652
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: