Provider Demographics
NPI:1942744859
Name:SUMMIT'S EDGE COUNSELING & PERSONAL DEVELOPMENT
Entity type:Organization
Organization Name:SUMMIT'S EDGE COUNSELING & PERSONAL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:LAPC
Authorized Official - Phone:888-551-5168
Mailing Address - Street 1:1640 POWERS FERRY RD SE
Mailing Address - Street 2:BLD: 5 STE: 110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:888-551-5168
Mailing Address - Fax:888-595-7622
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BLD: 5 STE: 110
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:888-551-5168
Practice Address - Fax:888-595-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty