Healthcare Provider Details

I. General information

NPI: 1922962125
Provider Name (Legal Business Name): SUMMER DAYS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N WILCOX DR STE C
KINGSPORT TN
37660-4986
US

IV. Provider business mailing address

1201 N WILCOX DR STE C
KINGSPORT TN
37660-4986
US

V. Phone/Fax

Practice location:
  • Phone: 423-218-9214
  • Fax:
Mailing address:
  • Phone: 423-218-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SUMMER AHMED
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 423-218-9214