=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548766231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESSICA F SUMMERS LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2018
-----------------------------------------------------
Last Update Date | 04/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9327 MIDLOTHIAN TPKE STE 2G
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-4944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-277-9034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2356 SCHENLEY DR
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-466-6895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. JESSICA FAYE SUMMERS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 434-466-6895
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904007055
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------