Provider Demographics
NPI:1174166391
Name:FALL, SUMMER RAIN (MS, LADC)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:RAIN
Last Name:FALL
Suffix:
Gender:F
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 NORTHEASTERN BLVD STE 10A
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3142
Mailing Address - Country:US
Mailing Address - Phone:603-945-5542
Mailing Address - Fax:603-577-1679
Practice Address - Street 1:74 NORTHEASTERN BLVD STE 10A
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3142
Practice Address - Country:US
Practice Address - Phone:603-945-5542
Practice Address - Fax:603-577-1679
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00921101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty