Basic Information
| Provider Information | |||||||||
| NPI: | 1003342692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMMINGS | ||||||||
| FirstName: | CHADONN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 W MONUMENT AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454023014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374223875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3905 KETTERING BLVD | ||||||||
| Address2: | |||||||||
| City: | MORIANE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372938300 | ||||||||
| FaxNumber: | 9375341347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2017 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S1600607 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | S 1600607 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.