Healthcare Provider Details

I. General information

NPI: 1578691333
Provider Name (Legal Business Name): SUMMIT CARE AND WELLNESS TREATMENT AND COUNSELING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 24TH ST
LINCOLN NE
68502-3003
US

IV. Provider business mailing address

1700 S 24TH ST
LINCOLN NE
68502-3003
US

V. Phone/Fax

Practice location:
  • Phone: 402-435-2273
  • Fax:
Mailing address:
  • Phone: 402-435-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number208494938
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number208494938
License Number StateNE

VIII. Authorized Official

Name: MS. NANETTE MARIE GINGERY
Title or Position: PRESIDENT/DIRECTOR/ADMINISTRATOR
Credential: MA, LMHP, LADC, LPC
Phone: 402-435-2273