Provider Demographics
NPI:1427763168
Name:VAIL, SUMMER LEIGH (PHD, LCMFT)
Entity type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:LEIGH
Last Name:VAIL
Suffix:
Gender:F
Credentials:PHD, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4053 BLACKMOOR ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7160
Mailing Address - Country:US
Mailing Address - Phone:205-765-3092
Mailing Address - Fax:
Practice Address - Street 1:884 JOHNNIE DODDS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3140
Practice Address - Country:US
Practice Address - Phone:785-367-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist