Individual
BRENT CUMMINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 NORTHGATE INDUSTRIAL DR, GRANITE CITY, IL 62040-6805
(618) 512-1800
Mailing address
50 NORTHGATE INDUSTRIAL DR, GRANITE CITY, IL 62040-6805
(618) 512-1800
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178.009554
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
23197
IL
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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