Provider Demographics
NPI:1093352734
Name:ELLERBEE, SUMMER MORGAN (MSW)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:MORGAN
Last Name:ELLERBEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 WOODWARD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2027
Mailing Address - Country:US
Mailing Address - Phone:313-656-4052
Mailing Address - Fax:313-656-4053
Practice Address - Street 1:4160 WOODWARD AVE FL 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2027
Practice Address - Country:US
Practice Address - Phone:313-656-4052
Practice Address - Fax:313-656-4053
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011015171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical