Healthcare Provider Details

I. General information

NPI: 1245229707
Provider Name (Legal Business Name): SUMMER G. WOODSIDE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 SAINT ANDREWS DR
LAURINBURG NC
28352-2154
US

IV. Provider business mailing address

8020 SAINT ANDREWS DR
LAURINBURG NC
28352-2154
US

V. Phone/Fax

Practice location:
  • Phone: 910-280-0036
  • Fax:
Mailing address:
  • Phone: 910-280-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005008
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: