Provider Demographics
NPI:1366119208
Name:SUMMERS, GWENDOLYN RENEE (MED, LGPC, NCC)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:RENEE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MED, LGPC, NCC
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:RENEE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W CROSS ST APT 369
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3672
Mailing Address - Country:US
Mailing Address - Phone:443-986-8584
Mailing Address - Fax:
Practice Address - Street 1:65 OLD SOLOMONS ISLAND RD STE 104
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3842
Practice Address - Country:US
Practice Address - Phone:443-218-8628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional