Healthcare Provider Details

I. General information

NPI: 1801537212
Provider Name (Legal Business Name): SUMMER ANNE POLLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

17620 MISTYBROOK LN
LOCUST NC
28097-5004
US

V. Phone/Fax

Practice location:
  • Phone: 800-706-9126
  • Fax:
Mailing address:
  • Phone: 757-288-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPO17395
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: