Healthcare Provider Details

I. General information

NPI: 1619515806
Provider Name (Legal Business Name): WILLIAM J CUMMINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PACKARD ST
ANN ARBOR MI
48108-2073
US

IV. Provider business mailing address

3800 PACKARD ST
ANN ARBOR MI
48108-2073
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-5058
  • Fax: 734-845-3462
Mailing address:
  • Phone: 724-845-5058
  • Fax: 734-845-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: