Healthcare Provider Details

I. General information

NPI: 1700614252
Provider Name (Legal Business Name): SUMMER BROOKE WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 MOUNT PLEASANT RD
CHESAPEAKE VA
23322-4043
US

IV. Provider business mailing address

208 MYRTLE LN
SOUTH MILLS NC
27976-9603
US

V. Phone/Fax

Practice location:
  • Phone: 757-632-7221
  • Fax:
Mailing address:
  • Phone: 229-322-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: