Provider Demographics
NPI:1710594890
Name:SUMMERS, HEIDI L (MS, LMFT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WOODBINE CT
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-3144
Mailing Address - Country:US
Mailing Address - Phone:443-421-0648
Mailing Address - Fax:
Practice Address - Street 1:212 WOODBINE CT
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-3144
Practice Address - Country:US
Practice Address - Phone:443-421-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist