MEDICARE: CUMMINS COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649741505	OTHER	NJ	NPPES

General Provider Information

NPI Number	:	1710503149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMMINS COUNSELING LLC

Provider Business Mailing Address
First Line	:	717 CARDINAL WAY
Second Line	:
City	:	GALLOWAY
State	:	NJ
Zip	:	08205-3102
Country	:	US
Telephone Number	:	609-373-2378
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 MAPLE AVE
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1213
Country	:	US
Telephone Number	:	609-373-2378
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHRISTINA JENNIFER CUMMINS
Credential	:	LPC
Telephone Number	:	609-373-2378

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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