Provider Demographics
NPI:1023254810
Name:SUMMEY, ROBERT III (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SUMMEY
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 HOLLY OAK LN
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-0003
Mailing Address - Country:US
Mailing Address - Phone:980-329-6306
Mailing Address - Fax:
Practice Address - Street 1:1552 UNION RD
Practice Address - Street 2:SUITE E
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5523
Practice Address - Country:US
Practice Address - Phone:704-833-0154
Practice Address - Fax:704-833-7076
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC7189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104095Medicaid