Provider Demographics
NPI:1487062824
Name:SUMMERLIN, MARY ANN (LPCA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:201 NEW BRIDGE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4736
Mailing Address - Country:US
Mailing Address - Phone:910-336-4958
Mailing Address - Fax:910-333-9742
Practice Address - Street 1:201 NEW BRIDGE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4736
Practice Address - Country:US
Practice Address - Phone:910-336-4958
Practice Address - Fax:910-333-9742
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS - 21026101YA0400X
NC11015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)