Provider Demographics
NPI:1083941801
Name:SUMMIT CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SUMMIT CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-481-8749
Mailing Address - Street 1:25484 POINT LOOKOUT RD
Mailing Address - Street 2:SUITE 302 B
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3801
Mailing Address - Country:US
Mailing Address - Phone:301-475-7822
Mailing Address - Fax:301-475-7822
Practice Address - Street 1:25484 POINT LOOKOUT RD
Practice Address - Street 2:SUITE 302 B
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3801
Practice Address - Country:US
Practice Address - Phone:301-475-7822
Practice Address - Fax:301-475-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty