Provider Demographics
NPI:1245229707
Name:WOODSIDE, SUMMER G (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:G
Last Name:WOODSIDE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-2154
Mailing Address - Country:US
Mailing Address - Phone:910-280-0036
Mailing Address - Fax:
Practice Address - Street 1:8020 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-2154
Practice Address - Country:US
Practice Address - Phone:910-280-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106110Medicaid
NC6106110Medicaid