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General NPI Number Information
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NPI Number | 1063707206
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Entity Type | Organization
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Legal Business Name | SUMMERVILLE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 900 ROUTE 168 SUITE A-4
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City | TURNERSVILLE
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State | NJ
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Zip | 08012
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Country | US
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Telephone | 856-343-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 129 PINTO DR
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City | SEWELL
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State | NJ
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Zip | 08080-1623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALLEN F SUMMERVILLE
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Credential | LCSW
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Telephone | 856-343-9889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SCO5364100
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License Number State | NJ
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