=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831276898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1207 EAST ST
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28786-3438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-456-6120
-----------------------------------------------------
Fax | 828-456-6164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1207 EAST ST
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28786-3438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-456-6120
-----------------------------------------------------
Fax | 828-456-6164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXCEUTIVE OFFICER
-----------------------------------------------------
Name | CARL D LOSACCO
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 828-456-6120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------