Healthcare Provider Details

I. General information

NPI: 1235125055
Provider Name (Legal Business Name): CUMBERLAND MOUNTAIN COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CUMBERLAND RD
CEDAR BLUFF VA
24609-1137
US

IV. Provider business mailing address

PO BOX 810
CEDAR BLUFF VA
24609-0810
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-6702
  • Fax: 276-964-5669
Mailing address:
  • Phone: 276-964-6702
  • Fax: 276-964-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. MARY F. COLE
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 276-964-6702