Healthcare Provider Details

I. General information

NPI: 1124942529
Provider Name (Legal Business Name): OLIVIA GRACE SUMMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1593 SPRING HILL RD STE 705
VIENNA VA
22182-2289
US

IV. Provider business mailing address

2215 N VAN DORN ST APT 301
ALEXANDRIA VA
22304-1078
US

V. Phone/Fax

Practice location:
  • Phone: 757-997-2699
  • Fax:
Mailing address:
  • Phone: 815-954-8059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019311
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: