Provider Demographics
NPI:1881461697
Name:CUMMINGS, KRESA MAUDE (PHARMD, MSW, LCAS)
Entity type:Individual
Prefix:
First Name:KRESA
Middle Name:MAUDE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PHARMD, MSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8263
Mailing Address - Country:US
Mailing Address - Phone:910-733-3614
Mailing Address - Fax:
Practice Address - Street 1:910 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4243
Practice Address - Country:US
Practice Address - Phone:910-222-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30938101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty