Healthcare Provider Details

I. General information

NPI: 1790994119
Provider Name (Legal Business Name): CRAIG L SUMMERS MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 LEROY GEORGE DR
CLYDE NC
28721-7408
US

IV. Provider business mailing address

1390 QUEENTOWN RD
CANTON NC
28716-6930
US

V. Phone/Fax

Practice location:
  • Phone: 828-246-5988
  • Fax:
Mailing address:
  • Phone: 828-246-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: