Healthcare Provider Details

I. General information

NPI: 1174353403
Provider Name (Legal Business Name): DANYELL CHENELL SUMMERS-CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 ANSEL RD
CLEVELAND OH
44108-3323
US

IV. Provider business mailing address

13000 WATTERSON AVE
CLEVELAND OH
44105-4545
US

V. Phone/Fax

Practice location:
  • Phone: 216-329-4927
  • Fax: 844-593-7239
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: