Provider Demographics
NPI:1487606638
Name:SUMMERS, TAMMY ANNE (MED, LPC)
Entity type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:ANNE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:134 WYTHE CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6226
Mailing Address - Country:US
Mailing Address - Phone:919-847-0949
Mailing Address - Fax:919-782-4770
Practice Address - Street 1:207 W MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4490
Practice Address - Country:US
Practice Address - Phone:919-782-7848
Practice Address - Fax:919-782-4770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC#533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC80960OtherBLUE CROSS BLUE SHIELD