Provider Demographics
NPI:1093308827
Name:GIVENS, SUMMER ROSE
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:ROSE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CHRISTMAS SEAL DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3347
Mailing Address - Country:US
Mailing Address - Phone:330-539-3909
Mailing Address - Fax:
Practice Address - Street 1:1300 CHRISTMAS SEAL DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3347
Practice Address - Country:US
Practice Address - Phone:330-949-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional