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General NPI Number Information
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NPI Number | 1386236263
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Entity Type | Organization
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Legal Business Name | SUMMIT RECOVERY LLC
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 549 E FRONT ST
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City | LOGAN
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State | OH
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Zip | 43138-1717
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Country | US
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Telephone | 740-279-9998
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Fax |
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Provider Business Mailing Address
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Address Line | 283 W HUNTER ST
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City | LOGAN
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State | OH
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Zip | 43138-1515
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Country | US
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Telephone | 740-279-9998
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ASHLEY BOOKWALTER
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Credential | LICDC-CS
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Telephone | 740-279-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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