Provider Demographics
NPI:1154474278
Name:EGGLESTON, SUMMER LESLIE (MFT, CSAC)
Entity Type:Individual
Prefix:MS
First Name:SUMMER
Middle Name:LESLIE
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:MFT, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-402 HOENE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1965
Mailing Address - Country:US
Mailing Address - Phone:808-756-2829
Mailing Address - Fax:
Practice Address - Street 1:75-127 LUNAPULE RD STE 15B
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2119
Practice Address - Country:US
Practice Address - Phone:808-327-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI#59106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist