Healthcare Provider Details

I. General information

NPI: 1760269187
Provider Name (Legal Business Name): SUMMER NICOLE ATHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 04/10/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28407 STATE ROUTE 7
MARIETTA OH
45750-5152
US

IV. Provider business mailing address

1862 COLLINS RD
WHIPPLE OH
45788-5318
US

V. Phone/Fax

Practice location:
  • Phone: 740-371-5160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number185654
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2410424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: