Provider Demographics
NPI:1396884128
Name:SUMMERS, CHAUNTEL MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHAUNTEL
Middle Name:MARIE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHAUNTEL
Other - Middle Name:MARIE
Other - Last Name:GUSTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:49 GUILFORD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7058
Mailing Address - Country:US
Mailing Address - Phone:910-987-6342
Mailing Address - Fax:910-436-2154
Practice Address - Street 1:690 N REILLY RD
Practice Address - Street 2:STE, 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5724
Practice Address - Country:US
Practice Address - Phone:910-991-2347
Practice Address - Fax:910-436-2154
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003761101YP2500X
NC7412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412OtherPROFESSIONAL COUNSELOR
PAPC003761OtherPROFESSIONAL COUNSELOR