Provider Demographics
NPI:1730446261
Name:CUMMINS, DAMION R (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:DAMION
Middle Name:R
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 STABLE RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3290
Mailing Address - Country:US
Mailing Address - Phone:318-355-1628
Mailing Address - Fax:
Practice Address - Street 1:206 E REYNOLDS DR
Practice Address - Street 2:F1
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2809
Practice Address - Country:US
Practice Address - Phone:318-202-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional