Healthcare Provider Details

I. General information

NPI: 1780522078
Provider Name (Legal Business Name): SUMMER BROSSEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13063 MISSION CHURCH RD
LOCUST NC
28097-7241
US

IV. Provider business mailing address

13063 MISSION CHURCH RD
LOCUST NC
28097-7241
US

V. Phone/Fax

Practice location:
  • Phone: 704-575-0565
  • Fax:
Mailing address:
  • Phone: 704-575-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005449
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: