Healthcare Provider Details

I. General information

NPI: 1184313272
Provider Name (Legal Business Name): SUMMER LEIGH DIDIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14635 S HARRELLS FERRY RD STE E
BATON ROUGE LA
70816-2959
US

IV. Provider business mailing address

10151 ANGELA DR
DENHAM SPRINGS LA
70706-1830
US

V. Phone/Fax

Practice location:
  • Phone: 225-349-8984
  • Fax:
Mailing address:
  • Phone: 225-454-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: